Ambulatory Surgery Center Fee Schedule

Ambulatory Surgery Center Fee Schedule Effective 01-01-09 The procedure codes and fee schedule amounts in this document do not necessarily indicate coverage or payment. All coverage and payments are subject to plan benefits, exclusions, limitations, and pre-authorization requirements. Please refer to the Uniform Medical Plan (UMP) Billing and Administrative Manual for Professional Providers and Certificate of Coverage. Fees in this publication are subject to change without notice. Although we make every effort to ensure the accuracy of the fees in our publications, changes or corrections may occur throughout the year. Visit the UMP web site at www.ump.hca.wa.gov to download the latest versions of this fee schedule, and all other UMP publications mentioned in this document. Current Procedural Terminology (CPT ) five-digit codes, descriptions, and other data only are copyright 2008 American Medical Association (AMA). All rights reserved. No fee schedules, basic units, relative values, or related listings are included in CPT. AMA does not directly or indirectly practice medicine or dispense medical services. AMA assumes no liability for data contained or not contained herein. Applicable FARS/DFARS Apply. CPT is a registered trademark of the AMA. HCA 54-904 (01-12-09)

2 UMP ASC Fee Schedule, Effective 01/1/09 UMP ASC Payment Policy Information General Information The Uniform Medical Plan (UMP) Ambulatory Surgery Center Fee Schedule has been revised effective January 1, 2009 and contains the maximum allowances for services provided in ambulatory surgery centers (ASC). All UMP coverage rules regarding the medical necessity of a given procedure for a given patient are applicable to ASC services in the same manner as all other covered services. The national correct coding initiative (NCCI) edits are also applied to ASC claims. ASC Payment Methodology and Conversion Factors Effective July 1, 2008, Uniform Medical Plan updated its ASC fee schedule using the Centers for Medicare and Medicaid Services (CMS) published expanded list of procedures covered in ASCs. In general, UMP will follows Medicare payment policies and billing requirements for ASCs. Effective January 1, 2009, UMP has expanded the list of procedures covered in an ASC to include the majority of procedures covered in an outpatient hospital setting. The revised ASC payment rates are based on the ambulatory payment classifications (APCs) used to group procedures under the Outpatient Prospective Payment System (OPPS). The standard ASC payment for covered surgical procedures is calculated by multiplying the UMP specific ASC conversion factor by the APC payment weight for each separately payable procedure. Effective for dates of service on or after January 1, 2009, the following conversion factors will apply. Conversion Factor Coverage Description $61.60 most surgical procedures $94.57 pain management and gastrointestinal procedures (see the fee schedule for a list of specific CPT and HCPCS codes paid using this conversion factor) UMP determined these conversions factors based on CMS publications, prior UMP utilization of ASC services and input from the ASC Provider community. The split conversion factors represent UMP s efforts to provide equality of reimbursement across all specialties. UMP will periodically update and review the conversion factors when warranted. Billing Information Ambulatory Surgery Centers should bill the same procedure code(s) reported by the surgeon. ASCs can submit electronic or paper claims and use either a CMS 1500 or UB-04 claim form for payment consideration. The ASC charges must be billed with place of service code "24." Modifer TC must be used unless the code has no professional component. Note: The SG modifier is no longer required by Medicare, however UMP will continue to accept it on the claim. The UMP ASC fee schedule uses Current Procedural Terminology (CPT ) and Healthcare Common Coding System (HCPCS) codes. For billing purposes, use the most recent edition of the CPT and HCPCS level II coding references, which include complete descriptions of the codes.

3 UMP ASC Fee Schedule, Effective 01/1/09 Bundled Services and Supplies ASC services for which payment is included in the ASC allowed amount for a covered procedure include, but are not limited to the following. Administrative, record keeping and housekeeping items and services Anesthesia supplies/materials Blood, blood plasma, and platelets Drugs and biologicals for which separate payment is not allowed under the outpatient prospective payment system (OPPS). Implanted DME and related accessories and supplies not on pass-through status Implanted prosthetic devices not on pass-through status, including intraocular lenses (IOLS) inserted during or subsequent to cataract surgery. Nursing, technician and related services Radiology services for which separate payment is not allowed under the OPPS and other diagnostic or therapeutic services or items integral to the surgical procedure (including routine pre-op lab services) Surgical dressings, surgical trays, supplies, splints, screws, casts, post-op shoes Use of ASC facilities (including operating/recovery rooms and patient preparation areas) ASC Services and Supplies that May be Paid Separately UMP will pay separately for certain covered ancillary services that are provided integral to covered surgical procedures in ASCs including the following. Brachytherapy sources Certain implantable items that have pass through status under OPPS Certain radiology services for which separate payment is allowed under the OPPS Corneal tissue procurement (HCPCS code V2785) Drugs and biologicals that are separately paid under the OPPS New Technology Intraocular Lens (NTIOLS) Other Services Provided by ASCs that May be Paid Separately Ambulance services Artificial limbs Durable medical equipment for use in the patient's home Leg, arm, back and neck braces Professional services, including; physician services, surgeon, assistant surgeon, anesthesiologist and nurse anesthetist Pre/post-operative professional services (E/M codes subject to global surgery rules) Services furnished by an independent laboratory Surgery Rules In general, the following procedure for multiple surgery rules applies. In some cases due to automated claims adjudication and additional logic built into the processing system, these rules may be overridden and procedures that might otherwise result in reduced payment may not have the reduction for multiple surgeries taken. Please contact UMP Customer Service if you have any questions regarding how the claim was processed for multiple surgeries as outlined below. Payment Rule for s (modifier 51)

4 UMP ASC Fee Schedule, Effective 01/1/09 If multiple procedures are performed on the same patient at the same operative session or on the same day, the total maximum allowance is equal to the sum of the following: 100% of the UMP ASC Fee Schedule allowed amount for the highest fee-schedule-valued procedure. 50% of the UMP ASC Fee Schedule allowed amount for any other ASC covered surgical procedure(s) Payment Rule for Bilateral s (modifier 50) When a bilateral procedure is performed, the UMP allowed charge is based on 150% of the the UMP ASC Fee Schedule amount. Providers must bill using the single procedure code with the modifier. Payment Rules for Terminated s UMP will not pay claims for an ASC procedure that is terminated either for non-medical or medical reasons before expending substantial resources. For example, UMP would not pay a claim for a scheduled surgery that was cancelled or postponed because the patient on intake complained of a cold or flu. Termination of a After Anesthesia (Modifier 74) An ASC may be paid when a medical complication arises causing the covered procedure to be terminated after inducement an the anesthetic agent. Resources of the facility are consumed in essentially the same manner and to the same extent as they would have been had the surgery been completed. In these circumstances, modifier 74 (representing a discontinued procedure after administration of anesthesia) must be present with the procedure code. Termination of a Before Anesthesia (Modifier 73) An ASC may be paid when a surgical procedure is terminated due to the onset of medical complications after the patient has been prepared for surgery and taken to the operating room but before anesthesia has been induced. Modifier 73 must be present with the procedure code. The UMP ASC Fee Schedule amount is generally reduced by 50% for payment of covered procedures in these situations. Note: supporting documentation may be requested on a periodic basis by UMP when modifiers 73 or 74 are used. Request for Pre-Authorization Pre-Authorization is not required for ASCs. In the unlikely event that the cost of a procedure (procedure plus implant) is estimated to exceed the UMP allowed amount ASCs may request a preauthorization. Fax the UMP at (425) 670-3197 and include the following information: Diagnosis code Provider/facility name, phone number, fax number Reason for requesting the pre-auth including supporting documentation Specific procedure being requested with CPT or HCPCS code Estimated cost of any implants (must submit invoice at the time of claim submission) UMP member number (beginning with W)

5 UMP ASC Fee Schedule, Effective 01/1/09 Pain Management s 27096 $667.18 62263 $1,370.18 62264 $1,370.18 62273 $387.41 62280 $667.18 62281 $667.18 62282 $667.18 62310 $667.18 62311 $667.18 62318 $667.18 62319 $667.18 64410 $667.18 64415 $387.41 64417 $387.41 64420 $387.41 64421 $387.41 64430 $667.18 64470 $667.18 64472 $387.41 64475 $667.18 64476 $219.54 64479 $667.18 64480 $387.41 64483 $667.18 64484 $387.41 64510 $667.18 64517 $667.18 64520 $667.18 64530 $667.18 64600 $1,370.18 64605 $1,370.18 64610 $1,370.18 64620 $667.18 64622 $1,370.18 64623 $667.18 64626 $1,370.18 64627 $219.54 64630 $667.18 64680 $1,370.18 64681 $1,370.18 G0260 $667.18 62287 $3,146.56 62350 $3,430.86 62355 $1,370.18 62360 $3,430.86 62361 $17,391.55 62362 $17,391.55 62365 $3,146.56 62367 $220.07 62368 $220.07 63650 $6,032.58 63660 $2,125.41 63685 $22,773.42 63688 $3,254.93 Gastrointestinal s 43200 $804.17 43202 $804.17 43235 $804.17 43239 $804.17 43243 $804.17 43245 $804.17 43247 $804.17 43248 $804.17 43249 $804.17 43250 $804.17 43251 $804.17 43255 $804.17 43450 $552.61 44360 $901.22 44361 $901.22 44377 $901.22 44386 $836.85 44388 $836.85 44389 $836.85 45170 $2,151.10 45331 $482.06 45333 $823.09 45338 $823.09 45339 $823.09 45355 $836.85 45378 $836.85 45380 $836.85 45381 $836.85 45382 $836.85 45383 $836.85 45384 $836.85 45385 $836.85 45560 $2,852.42 45990 $2,151.10 46040 $2,151.10 46060 $2,151.10 46080 $2,151.10 46200 $2,151.10 46220 $2,151.10 46230 $2,151.10 46250 $2,151.10 46260 $2,151.10 46270 $2,151.10 46280 $2,151.10 46615 $2,029.87 46924 $1,882.42 46947 $2,852.42

7 UMP ASC Fee Schedule, Effective 01/01/09 2009 ASC Fee Schedule 00100 $0.00 N 00102 $0.00 N 00103 $0.00 N 00104 $0.00 N 00120 $0.00 N 00124 $0.00 N 00126 $0.00 N 00140 $0.00 N 00142 $0.00 N 00144 $0.00 N 00145 $0.00 N 00147 $0.00 N 00148 $0.00 N 00160 $0.00 N 00162 $0.00 N 00164 $0.00 N 0016T $254.59 Y 00170 $0.00 N 00172 $0.00 N 00174 $0.00 N 0017T $254.59 Y 00190 $0.00 N 00210 $0.00 N 00212 $0.00 N 00216 $0.00 N 00218 $0.00 N 00220 $0.00 N 00222 $0.00 N 0027T $1,111.95 Y 0028T $0.00 N 00300 $0.00 N 0031T $0.00 N 00320 $0.00 N 00322 $0.00 N 00326 $0.00 N 0032T $0.00 N 00350 $0.00 N 00352 $0.00 N 00400 $0.00 N 00402 $0.00 N 00404 $0.00 N 00406 $0.00 N 00410 $0.00 N 0042T $0.00 N 00450 $0.00 N 00454 $0.00 N 0046T $991.73 Y 00470 $0.00 N 00472 $0.00 N 0047T $991.73 Y 00500 $0.00 N 00520 $0.00 N 00522 $0.00 N 00528 $0.00 N 00529 $0.00 N 00530 $0.00 N 00532 $0.00 N 00534 $0.00 N 00537 $0.00 N 00539 $0.00 N 00541 $0.00 N 00548 $0.00 N 00550 $0.00 N 00563 $0.00 N 00566 $0.00 N 00600 $0.00 N 00620 $0.00 N 00625 $0.00 N 00626 $0.00 N 0062T $1,798.04 Y 00630 $0.00 N 00634 $0.00 N 00635 $0.00 N 0063T $1,798.04 Y 00640 $0.00 N 0064T $34.97 N 0067T $185.46 N 0069T $0.00 N 00700 $0.00 N 00702 $0.00 N 0071T $3,800.37 N 0072T $3,800.37 N 00730 $0.00 N 0073T $336.21 N 00740 $0.00 N 00750 $0.00 N 00752 $0.00 N 00754 $0.00 N 00756 $0.00 N 00770 $0.00 N 00790 $0.00 N 00797 $0.00 N 00800 $0.00 N 00810 $0.00 N 00820 $0.00 N 00830 $0.00 N

8 UMP ASC Fee Schedule, Effective 01/01/09 00832 $0.00 N 00834 $0.00 N 00836 $0.00 N 00840 $0.00 N 00842 $0.00 N 0084T $123.67 Y 00851 $0.00 N 0085T $38.87 N 00860 $0.00 N 00862 $0.00 N 0086T $0.00 N 00870 $0.00 N 00872 $0.00 N 00873 $0.00 N 00880 $0.00 N 0088T $1,005.82 Y 00902 $0.00 N 00906 $0.00 N 00910 $0.00 N 00912 $0.00 N 00914 $0.00 N 00916 $0.00 N 00918 $0.00 N 00920 $0.00 N 00921 $0.00 N 00922 $0.00 N 00924 $0.00 N 00926 $0.00 N 00928 $0.00 N 00930 $0.00 N 00938 $0.00 N 00940 $0.00 N 00942 $0.00 N 00948 $0.00 N 00950 $0.00 N 00952 $0.00 N 01112 $0.00 N 01120 $0.00 N 01130 $0.00 N 01160 $0.00 N 01170 $0.00 N 01173 $0.00 N 01180 $0.00 N 01190 $0.00 N 01200 $0.00 N 01202 $0.00 N 01210 $0.00 N 01215 $0.00 N 01220 $0.00 N 01230 $0.00 N 0123T $1,427.58 Y 0124T $315.19 Y 01250 $0.00 N 01260 $0.00 N 01270 $0.00 N 01320 $0.00 N 01340 $0.00 N 01360 $0.00 N 0137T $679.66 Y 01380 $0.00 N 01382 $0.00 N 01390 $0.00 N 01392 $0.00 N 01400 $0.00 N 01420 $0.00 N 01430 $0.00 N 01432 $0.00 N 01440 $0.00 N 01462 $0.00 N 01464 $0.00 N 01470 $0.00 N 01472 $0.00 N 01474 $0.00 N 01480 $0.00 N 01482 $0.00 N 01484 $0.00 N 01490 $0.00 N 01500 $0.00 N 01520 $0.00 N 01522 $0.00 N 0159T $0.00 N 01610 $0.00 N 01620 $0.00 N 01622 $0.00 N 01630 $0.00 N 01650 $0.00 N 01670 $0.00 N 01680 $0.00 N 01682 $0.00 N 01710 $0.00 N 01712 $0.00 N 01714 $0.00 N 01716 $0.00 N 01730 $0.00 N 01732 $0.00 N 0173T $0.00 N 01740 $0.00 N 01742 $0.00 N 01744 $0.00 N 0174T $0.00 N 01758 $0.00 N 0175T $0.00 N 01760 $0.00 N 01770 $0.00 N

9 UMP ASC Fee Schedule, Effective 01/01/09 01772 $0.00 N 01780 $0.00 N 01782 $0.00 N 01810 $0.00 N 01820 $0.00 N 01829 $0.00 N 01830 $0.00 N 01832 $0.00 N 01840 $0.00 N 01842 $0.00 N 01844 $0.00 N 01850 $0.00 N 01852 $0.00 N 0185T $0.00 N 01860 $0.00 N 01916 $0.00 N 01920 $0.00 N 01922 $0.00 N 01924 $0.00 N 01925 $0.00 N 01926 $0.00 N 01930 $0.00 N 01931 $0.00 N 01932 $0.00 N 01933 $0.00 N 01935 $0.00 N 01936 $0.00 N 01951 $0.00 N 01952 $0.00 N 01953 $0.00 N 01958 $0.00 N 01960 $0.00 N 01961 $0.00 N 01962 $0.00 N 01963 $0.00 N 01965 $0.00 N 01966 $0.00 N 01967 $0.00 N 01968 $0.00 N 01969 $0.00 N 01991 $0.00 N 01992 $0.00 N 01996 $0.00 N 01999 $0.00 N 10021 $68.36 Y 10022 $266.53 Y 10040 $48.85 Y 10060 $86.64 Y 10061 $86.64 Y 10080 $86.64 Y 10081 $712.03 Y 10120 $86.64 Y 10121 $991.73 Y 10140 $712.03 Y 10160 $86.64 Y 10180 $1,128.45 Y 11000 $48.85 Y 11001 $48.85 Y 11010 $265.11 Y 11011 $265.11 Y 11012 $265.11 Y 11040 $89.90 Y 11041 $89.90 Y 11042 $163.87 Y 11043 $163.87 Y 11044 $423.89 Y 11055 $48.85 Y 11056 $48.85 Y 11057 $89.90 Y 11100 $48.85 Y 11101 $48.85 Y 11200 $48.85 Y 11201 $89.90 Y 11300 $48.85 Y 11301 $48.85 Y 11302 $48.85 Y 11303 $89.90 Y 11305 $48.85 Y 11306 $48.85 Y 11307 $48.85 Y 11308 $48.85 Y 11310 $48.85 Y 11311 $48.85 Y 11312 $48.85 Y 11313 $48.85 Y 11400 $265.11 Y 11401 $265.11 Y 11402 $265.11 Y 11403 $534.98 Y 11404 $991.73 Y 11406 $991.73 Y 11420 $534.98 Y 11421 $534.98 Y 11422 $534.98 Y 11423 $991.73 Y 11424 $991.73 Y 11426 $1,300.32 Y 11440 $265.11 Y 11441 $265.11 Y 11442 $534.98 Y 11443 $534.98 Y 11444 $534.98 Y 11446 $1,300.32 Y 11450 $1,300.32 Y

10 UMP ASC Fee Schedule, Effective 01/01/09 11451 $1,300.32 Y 11462 $1,300.32 Y 11463 $1,300.32 Y 11470 $1,300.32 Y 11471 $1,300.32 Y 11600 $265.11 Y 11601 $265.11 Y 11602 $265.11 Y 11603 $534.98 Y 11604 $534.98 Y 11606 $991.73 Y 11620 $534.98 Y 11621 $265.11 Y 11622 $534.98 Y 11623 $534.98 Y 11624 $991.73 Y 11626 $1,300.32 Y 11640 $265.11 Y 11641 $265.11 Y 11642 $534.98 Y 11643 $534.98 Y 11644 $991.73 Y 11646 $1,300.32 Y 11719 $48.85 Y 11720 $48.85 Y 11721 $48.85 Y 11730 $48.85 Y 11732 $48.85 Y 11740 $18.25 Y 11750 $265.11 Y 11752 $1,300.32 Y 11755 $265.11 Y 11760 $129.67 Y 11762 $926.79 Y 11765 $89.90 Y 11770 $1,300.32 Y 11771 $1,300.32 Y 11772 $1,300.32 Y 11900 $48.85 Y 11901 $48.85 Y 11920 $129.67 Y 11921 $129.67 Y 11922 $129.67 Y 11950 $78.80 Y 11951 $78.80 Y 11952 $78.80 Y 11954 $78.80 Y 11960 $1,244.70 Y 11970 $2,647.78 Y 11971 $1,300.32 Y 11976 $265.11 Y 11980 $38.87 N 11981 $38.87 N 11982 $38.87 N 11983 $38.87 N 12001 $78.80 Y 12002 $78.80 Y 12004 $78.80 Y 12005 $78.80 Y 12006 $78.80 Y 12007 $78.80 Y 12011 $78.80 Y 12013 $78.80 Y 12014 $78.80 Y 12015 $78.80 Y 12016 $78.80 Y 12017 $78.80 Y 12018 $78.80 Y 12020 $278.81 Y 12021 $278.81 Y 12031 $129.67 Y 12032 $129.67 Y 12034 $129.67 Y 12035 $129.67 Y 12036 $129.67 Y 12037 $129.67 Y 12041 $129.67 Y 12042 $129.67 Y 12044 $129.67 Y 12045 $129.67 Y 12046 $129.67 Y 12047 $129.67 Y 12051 $129.67 Y 12052 $129.67 Y 12053 $129.67 Y 12054 $129.67 Y 12055 $129.67 Y 12056 $129.67 Y 12057 $129.67 Y 13100 $278.81 Y 13101 $278.81 Y 13102 $278.81 Y 13120 $129.67 Y 13121 $278.81 Y 13122 $129.67 Y 13131 $278.81 Y 13132 $278.81 Y 13133 $278.81 Y 13150 $278.81 Y 13151 $278.81 Y 13152 $278.81 Y 13153 $129.67 Y 13160 $1,244.70 Y 14000 $926.79 Y

11 UMP ASC Fee Schedule, Effective 01/01/09 14001 $926.79 Y 14020 $926.79 Y 14021 $926.79 Y 14040 $926.79 Y 14041 $926.79 Y 14060 $926.79 Y 14061 $926.79 Y 14300 $1,244.70 Y 14350 $1,244.70 Y 15002 $278.81 Y 15003 $278.81 Y 15004 $278.81 Y 15005 $278.81 Y 15040 $129.67 Y 15050 $278.81 Y 15100 $1,244.70 Y 15101 $1,244.70 Y 15110 $278.81 Y 15111 $278.81 Y 15115 $278.81 Y 15116 $278.81 Y 15120 $1,244.70 Y 15121 $1,244.70 Y 15130 $926.79 Y 15131 $926.79 Y 15135 $926.79 Y 15136 $926.79 Y 15150 $278.81 Y 15151 $278.81 Y 15152 $278.81 Y 15155 $278.81 Y 15156 $278.81 Y 15157 $278.81 Y 15170 $129.67 Y 15171 $129.67 Y 15175 $278.81 Y 15176 $278.81 Y 15200 $926.79 Y 15201 $926.79 Y 15220 $926.79 Y 15221 $278.81 Y 15240 $926.79 Y 15241 $278.81 Y 15260 $926.79 Y 15261 $926.79 Y 15300 $278.81 Y 15301 $278.81 Y 15320 $278.81 Y 15321 $278.81 Y 15330 $278.81 Y 15331 $278.81 Y 15335 $278.81 Y 15336 $278.81 Y 15340 $129.67 Y 15341 $129.67 Y 15360 $129.67 Y 15361 $129.67 Y 15365 $129.67 Y 15366 $129.67 Y 15400 $278.81 Y 15401 $278.81 Y 15420 $278.81 Y 15421 $278.81 Y 15430 $278.81 Y 15431 $278.81 Y 15570 $1,244.70 Y 15572 $1,244.70 Y 15574 $1,244.70 Y 15576 $1,244.70 Y 15600 $1,244.70 Y 15610 $1,244.70 Y 15620 $1,244.70 Y 15630 $1,244.70 Y 15650 $1,244.70 Y 15731 $1,244.70 Y 15732 $1,244.70 Y 15734 $1,244.70 Y 15736 $1,244.70 Y 15738 $1,244.70 Y 15740 $926.79 Y 15750 $1,244.70 Y 15760 $1,244.70 Y 15770 $1,244.70 Y 15775 $78.80 Y 15776 $78.80 Y 15780 $1,300.32 Y 15781 $265.11 Y 15782 $265.11 Y 15783 $163.87 Y 15786 $48.85 Y 15787 $48.85 Y 15788 $48.85 Y 15789 $89.90 Y 15792 $89.90 Y 15793 $48.85 Y 15819 $129.67 Y 15820 $1,244.70 Y 15821 $1,244.70 Y 15822 $1,244.70 Y 15823 $1,244.70 Y 15824 $1,244.70 Y 15825 $1,244.70 Y 15826 $1,244.70 Y 15828 $1,244.70 Y

12 UMP ASC Fee Schedule, Effective 01/01/09 15829 $1,244.70 Y 15832 $1,300.32 Y 15833 $1,300.32 Y 15834 $1,300.32 Y 15835 $1,300.32 Y 15836 $991.73 Y 15837 $991.73 Y 15838 $991.73 Y 15839 $991.73 Y 15840 $1,244.70 Y 15841 $1,244.70 Y 15842 $1,244.70 Y 15845 $1,244.70 Y 15850 $163.87 Y 15851 $163.87 Y 15852 $38.87 N 15860 $38.87 N 15877 $1,244.70 Y 15920 $265.11 Y 15922 $1,244.70 Y 15931 $1,300.32 Y 15933 $1,300.32 Y 15934 $1,244.70 Y 15935 $1,244.70 Y 15936 $926.79 Y 15937 $1,244.70 Y 15940 $1,300.32 Y 15941 $1,300.32 Y 15944 $1,244.70 Y 15945 $1,244.70 Y 15946 $1,244.70 Y 15950 $1,300.32 Y 15951 $1,300.32 Y 15952 $926.79 Y 15953 $926.79 Y 15956 $926.79 Y 15958 $926.79 Y 15999 $265.11 Y 16000 $48.85 Y 16020 $89.90 Y 16025 $163.87 Y 16030 $163.87 Y 16035 $163.87 Y 17000 $48.85 Y 17003 $18.25 Y 17004 $163.87 Y 17106 $163.87 Y 17107 $163.87 Y 17108 $163.87 Y 17110 $48.85 Y 17111 $89.90 Y 17250 $89.90 Y 17260 $89.90 Y 17261 $89.90 Y 17262 $89.90 Y 17263 $89.90 Y 17264 $89.90 Y 17266 $163.87 Y 17270 $89.90 Y 17271 $89.90 Y 17272 $89.90 Y 17273 $163.87 Y 17274 $163.87 Y 17276 $163.87 Y 17280 $89.90 Y 17281 $163.87 Y 17282 $163.87 Y 17283 $163.87 Y 17284 $163.87 Y 17286 $163.87 Y 17311 $223.73 Y 17312 $223.73 Y 17313 $223.73 Y 17314 $223.73 Y 17315 $223.73 Y 17340 $48.85 Y 17360 $48.85 Y 17999 $18.25 Y 19000 $266.53 Y 19001 $68.36 Y 19020 $1,128.45 Y 19030 $0.00 N 19100 $266.53 Y 19101 $1,271.48 Y 19102 $438.25 Y 19103 $836.28 Y 19110 $1,271.48 Y 19112 $1,271.48 Y 19120 $1,271.48 Y 19125 $1,271.48 Y 19126 $1,271.48 Y 19260 $991.73 Y 19290 $0.00 N 19291 $0.00 N 19295 $0.00 N 19296 $3,485.04 Y 19297 $3,485.04 Y 19298 $3,485.04 Y 19301 $1,271.48 Y 19302 $2,452.77 Y 19303 $1,953.48 Y 19304 $1,953.48 Y 19307 $2,452.77 Y 19316 $1,953.48 Y

13 UMP ASC Fee Schedule, Effective 01/01/09 19318 $2,452.77 Y 19324 $2,452.77 Y 19325 $3,485.04 Y 19328 $1,953.48 Y 19330 $1,953.48 Y 19340 $2,452.77 Y 19342 $3,485.04 Y 19350 $1,271.48 Y 19355 $1,953.48 Y 19357 $3,485.04 Y 19366 $1,953.48 Y 19370 $1,953.48 Y 19371 $1,953.48 Y 19380 $2,452.77 Y 19396 $1,953.48 Y 19499 $1,271.48 Y 20000 $86.64 Y 20005 $1,310.12 Y 20100 $593.44 Y 20101 $1,244.70 Y 20102 $1,244.70 Y 20103 $593.44 Y 20150 $2,647.78 Y 20200 $991.73 Y 20205 $991.73 Y 20206 $438.25 Y 20220 $534.98 Y 20225 $534.98 Y 20240 $1,300.32 Y 20245 $1,300.32 Y 20250 $1,310.12 Y 20251 $1,310.12 Y 20500 $154.01 Y 20501 $0.00 N 20520 $265.11 Y 20525 $1,300.32 Y 20526 $142.99 Y 20550 $142.99 Y 20551 $142.99 Y 20552 $142.99 Y 20553 $142.99 Y 20555 $1,798.04 Y 20600 $142.99 Y 20605 $142.99 Y 20610 $142.99 Y 20612 $142.99 Y 20615 $266.53 Y 20650 $1,310.12 Y 20662 $1,310.12 Y 20663 $1,310.12 Y 20665 $38.87 N 20670 $991.73 Y 20680 $1,300.32 Y 20690 $1,798.04 Y 20692 $1,798.04 Y 20693 $1,310.12 Y 20694 $1,310.12 Y 20822 $1,620.67 Y 20900 $1,798.04 Y 20902 $1,798.04 Y 20910 $1,244.70 Y 20912 $1,244.70 Y 20920 $926.79 Y 20922 $926.79 Y 20924 $1,798.04 Y 20926 $278.81 Y 20950 $86.64 Y 20972 $2,726.85 Y 20973 $2,726.85 Y 20975 $0.00 N 20979 $38.87 N 20982 $2,647.78 Y 20985 $0.00 N 20986 $0.00 N 20987 $0.00 N 20999 $1,310.12 Y 21010 $1,476.90 Y 21015 $1,005.82 Y 21025 $2,456.37 Y 21026 $2,456.37 Y 21029 $2,456.37 Y 21030 $1,476.90 Y 21031 $1,476.90 Y 21032 $1,476.90 Y 21034 $2,456.37 Y 21040 $1,476.90 Y 21044 $2,456.37 Y 21046 $2,456.37 Y 21047 $2,456.37 Y 21048 $2,456.37 Y 21049 $2,456.37 Y 21050 $2,456.37 Y 21060 $2,456.37 Y 21070 $2,456.37 Y 21076 $1,476.90 Y 21077 $2,456.37 Y 21079 $2,456.37 Y 21080 $2,456.37 Y 21081 $2,456.37 Y 21082 $2,456.37 Y 21083 $2,456.37 Y 21084 $2,456.37 Y 21085 $1,005.82 Y 21086 $2,456.37 Y

14 UMP ASC Fee Schedule, Effective 01/01/09 21087 $2,456.37 Y 21088 $2,456.37 Y 21089 $154.01 Y 21100 $2,456.37 Y 21110 $458.74 Y 21116 $0.00 N 21120 $1,476.90 Y 21121 $1,476.90 Y 21122 $1,476.90 Y 21123 $1,476.90 Y 21125 $1,476.90 Y 21127 $2,456.37 Y 21137 $1,476.90 Y 21138 $2,456.37 Y 21139 $2,456.37 Y 21150 $2,456.37 Y 21175 $2,456.37 Y 21181 $1,476.90 Y 21195 $2,456.37 Y 21198 $2,456.37 Y 21199 $2,456.37 Y 21206 $2,456.37 Y 21208 $2,456.37 Y 21209 $2,456.37 Y 21210 $2,456.37 Y 21215 $2,456.37 Y 21230 $2,456.37 Y 21235 $1,476.90 Y 21240 $2,456.37 Y 21242 $2,456.37 Y 21243 $2,456.37 Y 21244 $2,456.37 Y 21245 $2,456.37 Y 21246 $2,456.37 Y 21248 $2,456.37 Y 21249 $2,456.37 Y 21260 $2,456.37 Y 21261 $2,456.37 Y 21263 $2,456.37 Y 21267 $2,456.37 Y 21270 $2,456.37 Y 21275 $2,456.37 Y 21280 $2,456.37 Y 21282 $1,005.82 Y 21295 $458.74 Y 21296 $1,476.90 Y 21299 $154.01 Y 21310 $154.01 Y 21315 $154.01 Y 21320 $1,005.82 Y 21325 $1,476.90 Y 21330 $1,476.90 Y 21335 $1,476.90 Y 21336 $1,611.35 Y 21337 $1,005.82 Y 21338 $1,476.90 Y 21339 $1,476.90 Y 21340 $2,456.37 Y 21345 $1,476.90 Y 21355 $2,456.37 Y 21356 $1,476.90 Y 21360 $1,476.90 Y 21365 $2,456.37 Y 21385 $2,456.37 Y 21390 $2,456.37 Y 21400 $458.74 Y 21401 $1,005.82 Y 21406 $2,456.37 Y 21407 $2,456.37 Y 21408 $2,456.37 Y 21421 $1,476.90 Y 21440 $1,476.90 Y 21445 $1,476.90 Y 21450 $154.01 Y 21451 $458.74 Y 21452 $1,005.82 Y 21453 $2,456.37 Y 21454 $1,476.90 Y 21461 $2,456.37 Y 21462 $2,456.37 Y 21465 $2,456.37 Y 21470 $2,456.37 Y 21480 $154.01 Y 21485 $1,005.82 Y 21490 $2,456.37 Y 21495 $1,005.82 Y 21497 $1,005.82 Y 21499 $154.01 Y 21501 $1,128.45 Y 21502 $1,310.12 Y 21550 $534.98 Y 21555 $1,300.32 Y 21556 $1,300.32 Y 21557 $1,300.32 Y 21600 $1,798.04 Y 21610 $1,798.04 Y 21685 $458.74 Y 21700 $1,310.12 Y 21720 $1,310.12 Y 21725 $86.64 Y 21742 $2,647.78 Y 21743 $2,647.78 Y 21800 $108.92 Y 21805 $1,611.35 Y

15 UMP ASC Fee Schedule, Effective 01/01/09 21820 $108.92 Y 21899 $154.01 Y 21920 $534.98 Y 21925 $1,300.32 Y 21930 $1,300.32 Y 21935 $1,300.32 Y 22100 $2,881.08 Y 22101 $2,881.08 Y 22102 $2,881.08 Y 22103 $2,881.08 Y 22222 $2,881.08 Y 22305 $108.92 Y 22310 $108.92 Y 22315 $108.92 Y 22505 $909.54 Y 22520 $1,798.04 Y 22521 $1,798.04 Y 22522 $1,798.04 Y 22612 $2,881.08 Y 22614 $2,881.08 Y 22851 $1,310.12 Y 22899 $1,310.12 Y 22900 $1,300.32 Y 22999 $1,310.12 Y 23000 $991.73 Y 23020 $2,647.78 Y 23030 $1,128.45 Y 23031 $1,128.45 Y 23035 $1,310.12 Y 23040 $1,798.04 Y 23044 $1,798.04 Y 23065 $534.98 Y 23066 $1,300.32 Y 23075 $991.73 Y 23076 $1,300.32 Y 23077 $1,300.32 Y 23100 $1,310.12 Y 23101 $1,798.04 Y 23105 $1,798.04 Y 23106 $1,798.04 Y 23107 $1,798.04 Y 23120 $1,798.04 Y 23125 $1,798.04 Y 23130 $2,647.78 Y 23140 $1,310.12 Y 23145 $1,798.04 Y 23146 $1,798.04 Y 23150 $1,798.04 Y 23155 $1,798.04 Y 23156 $1,798.04 Y 23170 $1,798.04 Y 23172 $1,798.04 Y 23174 $1,798.04 Y 23180 $1,798.04 Y 23182 $1,798.04 Y 23184 $1,798.04 Y 23190 $1,798.04 Y 23195 $1,798.04 Y 23330 $534.98 Y 23331 $1,300.32 Y 23350 $0.00 N 23395 $2,647.78 Y 23397 $4,892.37 Y 23400 $1,798.04 Y 23405 $1,798.04 Y 23406 $1,798.04 Y 23410 $2,647.78 Y 23412 $2,647.78 Y 23415 $2,647.78 Y 23420 $2,647.78 Y 23430 $2,647.78 Y 23440 $2,647.78 Y 23450 $4,892.37 Y 23455 $4,892.37 Y 23460 $4,892.37 Y 23462 $2,647.78 Y 23465 $4,892.37 Y 23466 $2,647.78 Y 23470 $7,527.60 Y 23480 $2,647.78 Y 23485 $4,892.37 Y 23490 $2,647.78 Y 23491 $4,892.37 Y 23500 $108.92 Y 23505 $108.92 Y 23515 $3,648.02 Y 23520 $108.92 Y 23525 $108.92 Y 23530 $2,532.23 Y 23532 $1,611.35 Y 23540 $108.92 Y 23545 $108.92 Y 23550 $2,532.23 Y 23552 $2,532.23 Y 23570 $108.92 Y 23575 $108.92 Y 23585 $3,648.02 Y 23600 $108.92 Y 23605 $108.92 Y 23615 $3,648.02 Y 23616 $3,648.02 Y 23620 $108.92 Y 23625 $108.92 Y 23630 $3,648.02 Y

16 UMP ASC Fee Schedule, Effective 01/01/09 23650 $108.92 Y 23655 $909.54 Y 23660 $2,532.23 Y 23665 $108.92 Y 23670 $3,648.02 Y 23675 $108.92 Y 23680 $2,532.23 Y 23700 $909.54 Y 23800 $4,892.37 Y 23802 $2,647.78 Y 23921 $926.79 Y 23929 $108.92 Y 23930 $1,128.45 Y 23931 $1,128.45 Y 23935 $1,310.12 Y 24000 $1,798.04 Y 24006 $1,798.04 Y 24065 $991.73 Y 24066 $991.73 Y 24075 $991.73 Y 24076 $1,300.32 Y 24077 $1,300.32 Y 24100 $1,310.12 Y 24101 $1,798.04 Y 24102 $1,798.04 Y 24105 $1,310.12 Y 24110 $1,310.12 Y 24115 $1,798.04 Y 24116 $1,798.04 Y 24120 $1,310.12 Y 24125 $1,798.04 Y 24126 $1,798.04 Y 24130 $1,798.04 Y 24134 $1,798.04 Y 24136 $1,798.04 Y 24138 $1,798.04 Y 24140 $1,798.04 Y 24145 $1,798.04 Y 24147 $1,798.04 Y 24149 $1,798.04 Y 24150 $2,647.78 Y 24151 $4,892.37 Y 24152 $2,647.78 Y 24153 $4,892.37 Y 24155 $2,647.78 Y 24160 $1,798.04 Y 24164 $1,798.04 Y 24200 $265.11 Y 24201 $991.73 Y 24220 $0.00 N 24300 $909.54 Y 24301 $1,798.04 Y 24305 $1,798.04 Y 24310 $1,310.12 Y 24320 $2,647.78 Y 24330 $4,892.37 Y 24331 $2,647.78 Y 24332 $1,310.12 Y 24340 $2,647.78 Y 24341 $2,647.78 Y 24342 $2,647.78 Y 24343 $1,798.04 Y 24344 $4,892.37 Y 24345 $1,798.04 Y 24346 $2,647.78 Y 24357 $1,798.04 Y 24358 $1,798.04 Y 24359 $1,798.04 Y 24360 $2,211.61 Y 24361 $7,527.60 Y 24362 $3,134.56 Y 24363 $7,527.60 Y 24365 $2,211.61 Y 24366 $7,527.60 Y 24400 $1,798.04 Y 24410 $1,798.04 Y 24420 $2,647.78 Y 24430 $4,892.37 Y 24435 $4,892.37 Y 24470 $2,647.78 Y 24495 $1,798.04 Y 24498 $4,892.37 Y 24500 $108.92 Y 24505 $108.92 Y 24515 $3,648.02 Y 24516 $3,648.02 Y 24530 $108.92 Y 24535 $108.92 Y 24538 $1,611.35 Y 24545 $3,648.02 Y 24546 $3,648.02 Y 24560 $108.92 Y 24565 $108.92 Y 24566 $1,611.35 Y 24575 $3,648.02 Y 24576 $108.92 Y 24577 $108.92 Y 24579 $3,648.02 Y 24582 $1,611.35 Y 24586 $3,648.02 Y 24587 $3,648.02 Y 24600 $108.92 Y 24605 $909.54 Y 24615 $3,648.02 Y

17 UMP ASC Fee Schedule, Effective 01/01/09 24620 $108.92 Y 24635 $3,648.02 Y 24640 $108.92 Y 24650 $108.92 Y 24655 $108.92 Y 24665 $2,532.23 Y 24666 $3,648.02 Y 24670 $108.92 Y 24675 $108.92 Y 24685 $2,532.23 Y 24800 $2,647.78 Y 24802 $2,647.78 Y 24925 $1,310.12 Y 24935 $4,892.37 Y 24999 $108.92 Y 25000 $1,310.12 Y 25001 $1,310.12 Y 25020 $1,310.12 Y 25023 $1,798.04 Y 25024 $1,798.04 Y 25025 $1,798.04 Y 25028 $1,310.12 Y 25031 $1,310.12 Y 25035 $1,310.12 Y 25040 $1,798.04 Y 25065 $534.98 Y 25066 $1,300.32 Y 25075 $991.73 Y 25076 $1,300.32 Y 25077 $1,300.32 Y 25085 $1,310.12 Y 25100 $1,310.12 Y 25101 $1,798.04 Y 25105 $1,798.04 Y 25107 $1,798.04 Y 25109 $1,310.12 Y 25110 $1,310.12 Y 25111 $1,014.13 Y 25112 $1,014.13 Y 25115 $1,310.12 Y 25116 $1,310.12 Y 25118 $1,798.04 Y 25119 $1,798.04 Y 25120 $1,798.04 Y 25125 $1,798.04 Y 25126 $1,798.04 Y 25130 $1,798.04 Y 25135 $1,798.04 Y 25136 $1,798.04 Y 25145 $1,798.04 Y 25150 $1,798.04 Y 25151 $1,798.04 Y 25170 $2,647.78 Y 25210 $1,620.67 Y 25215 $1,620.67 Y 25230 $1,798.04 Y 25240 $1,798.04 Y 25246 $0.00 N 25248 $1,310.12 Y 25250 $1,798.04 Y 25251 $1,798.04 Y 25259 $108.92 Y 25260 $1,798.04 Y 25263 $1,798.04 Y 25265 $1,798.04 Y 25270 $1,798.04 Y 25272 $1,798.04 Y 25274 $1,798.04 Y 25275 $1,798.04 Y 25280 $1,798.04 Y 25290 $1,798.04 Y 25295 $1,310.12 Y 25300 $1,798.04 Y 25301 $1,798.04 Y 25310 $2,647.78 Y 25312 $2,647.78 Y 25315 $2,647.78 Y 25316 $4,892.37 Y 25320 $2,647.78 Y 25332 $2,211.61 Y 25335 $2,647.78 Y 25337 $2,647.78 Y 25350 $4,892.37 Y 25355 $2,647.78 Y 25360 $1,798.04 Y 25365 $1,798.04 Y 25370 $2,647.78 Y 25375 $2,647.78 Y 25390 $1,798.04 Y 25391 $2,647.78 Y 25392 $1,798.04 Y 25393 $2,647.78 Y 25394 $1,014.13 Y 25400 $4,892.37 Y 25405 $4,892.37 Y 25415 $4,892.37 Y 25420 $4,892.37 Y 25425 $2,647.78 Y 25426 $2,647.78 Y 25430 $1,620.67 Y 25431 $1,620.67 Y 25440 $4,892.37 Y 25441 $7,527.60 Y 25442 $7,527.60 Y

18 UMP ASC Fee Schedule, Effective 01/01/09 25443 $3,134.56 Y 25444 $3,134.56 Y 25445 $3,134.56 Y 25446 $7,527.60 Y 25447 $2,211.61 Y 25449 $2,211.61 Y 25450 $2,647.78 Y 25455 $2,647.78 Y 25490 $2,647.78 Y 25491 $2,647.78 Y 25492 $2,647.78 Y 25500 $108.92 Y 25505 $108.92 Y 25515 $2,532.23 Y 25520 $108.92 Y 25525 $2,532.23 Y 25526 $2,532.23 Y 25530 $108.92 Y 25535 $108.92 Y 25545 $2,532.23 Y 25560 $108.92 Y 25565 $108.92 Y 25574 $3,648.02 Y 25575 $3,648.02 Y 25600 $108.92 Y 25605 $108.92 Y 25606 $1,611.35 Y 25607 $3,648.02 Y 25608 $3,648.02 Y 25609 $3,648.02 Y 25622 $108.92 Y 25624 $108.92 Y 25628 $2,532.23 Y 25630 $108.92 Y 25635 $108.92 Y 25645 $2,532.23 Y 25650 $108.92 Y 25651 $1,611.35 Y 25652 $2,532.23 Y 25660 $108.92 Y 25670 $1,611.35 Y 25671 $1,611.35 Y 25675 $108.92 Y 25676 $1,611.35 Y 25680 $108.92 Y 25685 $1,611.35 Y 25690 $108.92 Y 25695 $1,611.35 Y 25800 $4,892.37 Y 25805 $2,647.78 Y 25810 $4,892.37 Y 25820 $1,014.13 Y 25825 $4,892.37 Y 25830 $4,892.37 Y 25907 $1,310.12 Y 25922 $1,310.12 Y 25929 $926.79 Y 25931 $1,310.12 Y 25999 $108.92 Y 26010 $86.64 Y 26011 $712.03 Y 26020 $1,014.13 Y 26025 $1,014.13 Y 26030 $1,014.13 Y 26034 $1,014.13 Y 26035 $1,014.13 Y 26037 $1,014.13 Y 26040 $1,620.67 Y 26045 $1,620.67 Y 26055 $1,014.13 Y 26060 $1,014.13 Y 26070 $1,014.13 Y 26075 $1,014.13 Y 26080 $1,014.13 Y 26100 $1,014.13 Y 26105 $1,014.13 Y 26110 $1,014.13 Y 26115 $1,300.32 Y 26116 $1,300.32 Y 26117 $1,300.32 Y 26121 $1,620.67 Y 26123 $1,620.67 Y 26125 $1,014.13 Y 26130 $1,014.13 Y 26135 $1,620.67 Y 26140 $1,014.13 Y 26145 $1,014.13 Y 26160 $1,014.13 Y 26170 $1,014.13 Y 26180 $1,014.13 Y 26185 $1,014.13 Y 26200 $1,014.13 Y 26205 $1,620.67 Y 26210 $1,014.13 Y 26215 $1,014.13 Y 26230 $1,014.13 Y 26235 $1,014.13 Y 26236 $1,014.13 Y 26250 $1,014.13 Y 26255 $1,620.67 Y 26260 $1,014.13 Y 26261 $1,014.13 Y 26262 $1,014.13 Y 26320 $991.73 Y

19 UMP ASC Fee Schedule, Effective 01/01/09 26340 $108.92 Y 26350 $1,620.67 Y 26352 $1,620.67 Y 26356 $1,620.67 Y 26357 $1,620.67 Y 26358 $1,620.67 Y 26370 $1,620.67 Y 26372 $1,620.67 Y 26373 $1,620.67 Y 26390 $1,620.67 Y 26392 $1,620.67 Y 26410 $1,014.13 Y 26412 $1,620.67 Y 26415 $1,620.67 Y 26416 $1,620.67 Y 26418 $1,014.13 Y 26420 $1,620.67 Y 26426 $1,620.67 Y 26428 $1,620.67 Y 26432 $1,014.13 Y 26433 $1,014.13 Y 26434 $1,620.67 Y 26437 $1,014.13 Y 26440 $1,014.13 Y 26442 $1,620.67 Y 26445 $1,014.13 Y 26449 $1,620.67 Y 26450 $1,014.13 Y 26455 $1,014.13 Y 26460 $1,014.13 Y 26471 $1,014.13 Y 26474 $1,014.13 Y 26476 $1,014.13 Y 26477 $1,014.13 Y 26478 $1,014.13 Y 26479 $1,014.13 Y 26480 $1,620.67 Y 26483 $1,620.67 Y 26485 $1,620.67 Y 26489 $1,620.67 Y 26490 $1,620.67 Y 26492 $1,620.67 Y 26494 $1,620.67 Y 26496 $1,620.67 Y 26497 $1,620.67 Y 26498 $1,620.67 Y 26499 $1,620.67 Y 26500 $1,014.13 Y 26502 $1,620.67 Y 26508 $1,014.13 Y 26510 $1,620.67 Y 26516 $1,620.67 Y 26517 $1,620.67 Y 26518 $1,620.67 Y 26520 $1,014.13 Y 26525 $1,014.13 Y 26530 $2,211.61 Y 26531 $3,134.56 Y 26535 $2,211.61 Y 26536 $3,134.56 Y 26540 $1,014.13 Y 26541 $1,620.67 Y 26542 $1,014.13 Y 26545 $1,620.67 Y 26546 $1,620.67 Y 26548 $1,620.67 Y 26550 $1,620.67 Y 26555 $1,620.67 Y 26560 $1,014.13 Y 26561 $1,620.67 Y 26562 $1,620.67 Y 26565 $1,620.67 Y 26567 $1,620.67 Y 26568 $1,620.67 Y 26580 $1,014.13 Y 26587 $1,014.13 Y 26590 $1,014.13 Y 26591 $1,620.67 Y 26593 $1,014.13 Y 26596 $1,014.13 Y 26600 $108.92 Y 26605 $108.92 Y 26607 $108.92 Y 26608 $1,611.35 Y 26615 $2,532.23 Y 26641 $108.92 Y 26645 $108.92 Y 26650 $1,611.35 Y 26665 $2,532.23 Y 26670 $108.92 Y 26675 $108.92 Y 26676 $1,611.35 Y 26685 $1,611.35 Y 26686 $3,648.02 Y 26700 $108.92 Y 26705 $108.92 Y 26706 $108.92 Y 26715 $1,611.35 Y 26720 $108.92 Y 26725 $108.92 Y 26727 $1,611.35 Y 26735 $1,611.35 Y 26740 $108.92 Y 26742 $108.92 Y

20 UMP ASC Fee Schedule, Effective 01/01/09 26746 $1,611.35 Y 26750 $108.92 Y 26755 $108.92 Y 26756 $1,611.35 Y 26765 $1,611.35 Y 26770 $108.92 Y 26775 $909.54 Y 26776 $1,611.35 Y 26785 $1,611.35 Y 26820 $1,620.67 Y 26841 $1,620.67 Y 26842 $1,620.67 Y 26843 $1,620.67 Y 26844 $1,620.67 Y 26850 $1,620.67 Y 26852 $1,620.67 Y 26860 $1,620.67 Y 26861 $1,620.67 Y 26862 $1,620.67 Y 26863 $1,620.67 Y 26910 $1,620.67 Y 26951 $1,014.13 Y 26952 $1,014.13 Y 26989 $108.92 Y 26990 $1,310.12 Y 26991 $1,310.12 Y 26992 $1,310.12 Y 27000 $1,310.12 Y 27001 $1,798.04 Y 27003 $1,798.04 Y 27006 $1,798.04 Y 27033 $2,647.78 Y 27035 $2,647.78 Y 27040 $534.98 Y 27041 $534.98 Y 27047 $1,300.32 Y 27048 $1,300.32 Y 27049 $1,300.32 Y 27050 $1,310.12 Y 27052 $1,310.12 Y 27060 $1,310.12 Y 27062 $1,310.12 Y 27065 $1,310.12 Y 27066 $1,798.04 Y 27067 $1,798.04 Y 27080 $1,798.04 Y 27086 $534.98 Y 27087 $1,310.12 Y 27093 $0.00 N 27095 $0.00 N 27096 $667.18 Y 27097 $1,798.04 Y 27098 $1,798.04 Y 27100 $2,647.78 Y 27105 $2,647.78 Y 27110 $2,647.78 Y 27111 $2,647.78 Y 27193 $108.92 Y 27194 $909.54 Y 27200 $108.92 Y 27202 $2,532.23 Y 27216 $1,798.04 Y 27220 $108.92 Y 27230 $108.92 Y 27235 $1,798.04 Y 27238 $108.92 Y 27246 $108.92 Y 27250 $108.92 Y 27252 $909.54 Y 27256 $108.92 Y 27257 $909.54 Y 27265 $108.92 Y 27266 $909.54 Y 27267 $108.92 Y 27275 $909.54 Y 27299 $108.92 Y 27301 $1,128.45 Y 27305 $1,310.12 Y 27306 $1,310.12 Y 27307 $1,310.12 Y 27310 $1,798.04 Y 27323 $534.98 Y 27324 $1,300.32 Y 27325 $1,111.95 Y 27326 $1,111.95 Y 27327 $1,300.32 Y 27328 $1,300.32 Y 27329 $1,300.32 Y 27330 $1,798.04 Y 27331 $1,798.04 Y 27332 $1,798.04 Y 27333 $1,798.04 Y 27334 $1,798.04 Y 27335 $1,798.04 Y 27340 $1,310.12 Y 27345 $1,310.12 Y 27347 $1,310.12 Y 27350 $1,798.04 Y 27355 $1,798.04 Y 27356 $1,798.04 Y 27357 $1,798.04 Y 27358 $1,798.04 Y 27360 $1,798.04 Y 27370 $0.00 N

21 UMP ASC Fee Schedule, Effective 01/01/09 27372 $1,300.32 Y 27380 $1,310.12 Y 27381 $1,310.12 Y 27385 $1,310.12 Y 27386 $1,310.12 Y 27390 $1,310.12 Y 27391 $1,310.12 Y 27392 $1,310.12 Y 27393 $1,798.04 Y 27394 $1,798.04 Y 27395 $2,647.78 Y 27396 $1,798.04 Y 27397 $2,647.78 Y 27400 $2,647.78 Y 27403 $1,798.04 Y 27405 $2,647.78 Y 27407 $4,892.37 Y 27409 $2,647.78 Y 27412 $2,815.46 Y 27415 $2,815.46 Y 27416 $2,647.78 Y 27418 $2,647.78 Y 27420 $2,647.78 Y 27422 $2,647.78 Y 27424 $2,647.78 Y 27425 $1,798.04 Y 27427 $2,647.78 Y 27428 $4,892.37 Y 27429 $4,892.37 Y 27430 $2,647.78 Y 27435 $2,647.78 Y 27437 $2,211.61 Y 27438 $3,134.56 Y 27440 $2,211.61 Y 27441 $2,211.61 Y 27442 $2,211.61 Y 27443 $2,211.61 Y 27446 $16,919.16 Y 27475 $1,798.04 Y 27496 $1,310.12 Y 27497 $1,310.12 Y 27498 $1,310.12 Y 27499 $1,310.12 Y 27500 $108.92 Y 27501 $108.92 Y 27502 $108.92 Y 27503 $108.92 Y 27508 $108.92 Y 27509 $1,611.35 Y 27510 $108.92 Y 27516 $108.92 Y 27517 $108.92 Y 27520 $108.92 Y 27524 $2,532.23 Y 27530 $108.92 Y 27532 $108.92 Y 27535 $2,532.23 Y 27538 $108.92 Y 27550 $108.92 Y 27552 $909.54 Y 27560 $108.92 Y 27562 $909.54 Y 27566 $2,532.23 Y 27570 $909.54 Y 27594 $1,310.12 Y 27599 $108.92 Y 27600 $1,310.12 Y 27601 $1,310.12 Y 27602 $1,310.12 Y 27603 $1,128.45 Y 27604 $1,310.12 Y 27605 $1,282.98 Y 27606 $1,310.12 Y 27607 $1,310.12 Y 27610 $1,798.04 Y 27612 $1,798.04 Y 27613 $534.98 Y 27614 $1,300.32 Y 27615 $1,798.04 Y 27618 $991.73 Y 27619 $1,300.32 Y 27620 $1,798.04 Y 27625 $1,798.04 Y 27626 $1,798.04 Y 27630 $1,310.12 Y 27635 $1,798.04 Y 27637 $1,798.04 Y 27638 $1,798.04 Y 27640 $2,647.78 Y 27641 $1,798.04 Y 27647 $2,647.78 Y 27648 $0.00 N 27650 $2,647.78 Y 27652 $4,892.37 Y 27654 $2,647.78 Y 27656 $1,310.12 Y 27658 $1,310.12 Y 27659 $1,310.12 Y 27664 $1,310.12 Y 27665 $1,798.04 Y 27675 $1,310.12 Y 27676 $1,798.04 Y 27680 $1,798.04 Y 27681 $1,798.04 Y

22 UMP ASC Fee Schedule, Effective 01/01/09 27685 $1,798.04 Y 27686 $1,798.04 Y 27687 $1,798.04 Y 27690 $2,647.78 Y 27691 $2,647.78 Y 27692 $2,647.78 Y 27695 $1,798.04 Y 27696 $1,798.04 Y 27698 $1,798.04 Y 27700 $2,211.61 Y 27704 $1,310.12 Y 27705 $2,647.78 Y 27707 $1,310.12 Y 27709 $1,798.04 Y 27720 $2,532.23 Y 27722 $3,648.02 Y 27726 $1,611.35 Y 27730 $1,798.04 Y 27732 $1,798.04 Y 27734 $1,798.04 Y 27740 $1,798.04 Y 27742 $2,647.78 Y 27745 $4,892.37 Y 27750 $108.92 Y 27752 $108.92 Y 27756 $1,611.35 Y 27758 $2,532.23 Y 27759 $3,648.02 Y 27760 $108.92 Y 27762 $108.92 Y 27766 $2,532.23 Y 27767 $108.92 Y 27768 $108.92 Y 27769 $2,532.23 Y 27780 $108.92 Y 27781 $108.92 Y 27784 $2,532.23 Y 27786 $108.92 Y 27788 $108.92 Y 27792 $2,532.23 Y 27808 $108.92 Y 27810 $108.92 Y 27814 $2,532.23 Y 27816 $108.92 Y 27818 $108.92 Y 27822 $2,532.23 Y 27823 $3,648.02 Y 27824 $108.92 Y 27825 $108.92 Y 27826 $2,532.23 Y 27827 $3,648.02 Y 27828 $3,648.02 Y 27829 $2,532.23 Y 27830 $108.92 Y 27831 $108.92 Y 27832 $2,532.23 Y 27840 $108.92 Y 27842 $909.54 Y 27846 $2,532.23 Y 27848 $2,532.23 Y 27860 $909.54 Y 27870 $4,892.37 Y 27871 $4,892.37 Y 27884 $1,310.12 Y 27889 $1,798.04 Y 27892 $1,310.12 Y 27893 $1,310.12 Y 27894 $1,310.12 Y 27899 $108.92 Y 28001 $712.03 Y 28002 $1,310.12 Y 28003 $1,310.12 Y 28005 $1,282.98 Y 28008 $1,282.98 Y 28010 $1,282.98 Y 28011 $1,282.98 Y 28020 $1,282.98 Y 28022 $1,282.98 Y 28024 $1,282.98 Y 28035 $1,111.95 Y 28043 $1,300.32 Y 28045 $1,282.98 Y 28046 $1,282.98 Y 28050 $1,282.98 Y 28052 $1,282.98 Y 28054 $1,282.98 Y 28055 $1,111.95 Y 28060 $1,282.98 Y 28062 $1,282.98 Y 28070 $1,282.98 Y 28072 $1,282.98 Y 28080 $1,282.98 Y 28086 $1,282.98 Y 28088 $1,282.98 Y 28090 $1,282.98 Y 28092 $1,282.98 Y 28100 $1,282.98 Y 28102 $2,726.85 Y 28103 $2,726.85 Y 28104 $1,282.98 Y 28106 $2,726.85 Y 28107 $2,726.85 Y 28108 $1,282.98 Y 28110 $1,282.98 Y

23 UMP ASC Fee Schedule, Effective 01/01/09 28111 $1,282.98 Y 28112 $1,282.98 Y 28113 $1,282.98 Y 28114 $1,282.98 Y 28116 $1,282.98 Y 28118 $1,282.98 Y 28119 $1,282.98 Y 28120 $1,282.98 Y 28122 $1,282.98 Y 28124 $1,282.98 Y 28126 $1,282.98 Y 28130 $1,282.98 Y 28140 $1,282.98 Y 28150 $1,282.98 Y 28153 $1,282.98 Y 28160 $1,282.98 Y 28171 $1,282.98 Y 28173 $1,282.98 Y 28175 $1,282.98 Y 28190 $265.11 Y 28192 $991.73 Y 28193 $534.98 Y 28200 $1,282.98 Y 28202 $1,282.98 Y 28208 $1,282.98 Y 28210 $2,726.85 Y 28220 $1,282.98 Y 28222 $1,282.98 Y 28225 $1,282.98 Y 28226 $1,282.98 Y 28230 $1,282.98 Y 28232 $1,282.98 Y 28234 $1,282.98 Y 28238 $2,726.85 Y 28240 $1,282.98 Y 28250 $1,282.98 Y 28260 $1,282.98 Y 28261 $1,282.98 Y 28262 $1,282.98 Y 28264 $2,726.85 Y 28270 $1,282.98 Y 28272 $1,282.98 Y 28280 $1,282.98 Y 28285 $1,282.98 Y 28286 $1,282.98 Y 28288 $1,282.98 Y 28289 $1,282.98 Y 28290 $1,812.00 Y 28292 $1,812.00 Y 28293 $1,812.00 Y 28294 $1,812.00 Y 28296 $1,812.00 Y 28297 $1,812.00 Y 28298 $1,812.00 Y 28299 $1,812.00 Y 28300 $2,726.85 Y 28302 $1,282.98 Y 28304 $2,726.85 Y 28305 $2,726.85 Y 28306 $1,282.98 Y 28307 $1,282.98 Y 28308 $1,282.98 Y 28309 $2,726.85 Y 28310 $1,282.98 Y 28312 $1,282.98 Y 28313 $1,282.98 Y 28315 $1,282.98 Y 28320 $2,726.85 Y 28322 $2,726.85 Y 28340 $1,282.98 Y 28341 $1,282.98 Y 28344 $1,282.98 Y 28345 $1,282.98 Y 28360 $2,726.85 Y 28400 $108.92 Y 28405 $108.92 Y 28406 $1,611.35 Y 28415 $3,648.02 Y 28420 $2,532.23 Y 28430 $108.92 Y 28435 $108.92 Y 28436 $1,611.35 Y 28445 $2,532.23 Y 28446 $2,726.85 Y 28450 $108.92 Y 28455 $108.92 Y 28456 $1,611.35 Y 28465 $2,532.23 Y 28470 $108.92 Y 28475 $108.92 Y 28476 $1,611.35 Y 28485 $2,532.23 Y 28490 $108.92 Y 28495 $108.92 Y 28496 $1,611.35 Y 28505 $1,611.35 Y 28510 $108.92 Y 28515 $108.92 Y 28525 $1,611.35 Y 28530 $108.92 Y 28531 $1,611.35 Y 28540 $108.92 Y 28545 $1,611.35 Y 28546 $1,611.35 Y

24 UMP ASC Fee Schedule, Effective 01/01/09 28555 $2,532.23 Y 28570 $108.92 Y 28575 $108.92 Y 28576 $1,611.35 Y 28585 $1,611.35 Y 28600 $108.92 Y 28605 $108.92 Y 28606 $1,611.35 Y 28615 $2,532.23 Y 28630 $108.92 Y 28635 $909.54 Y 28636 $1,611.35 Y 28645 $1,611.35 Y 28660 $108.92 Y 28665 $909.54 Y 28666 $1,611.35 Y 28675 $1,611.35 Y 28705 $2,726.85 Y 28715 $4,892.37 Y 28725 $2,726.85 Y 28730 $2,726.85 Y 28735 $2,726.85 Y 28737 $2,726.85 Y 28740 $2,726.85 Y 28750 $2,726.85 Y 28755 $1,282.98 Y 28760 $2,726.85 Y 28810 $1,282.98 Y 28820 $1,282.98 Y 28825 $1,282.98 Y 28899 $108.92 Y 29000 $67.33 N 29010 $141.12 N 29015 $141.12 N 29020 $67.33 N 29025 $67.33 N 29035 $141.12 N 29040 $67.33 N 29044 $141.12 N 29046 $141.12 N 29049 $67.33 N 29055 $141.12 N 29058 $67.33 N 29065 $141.12 N 29075 $141.12 N 29085 $67.33 N 29086 $67.33 N 29105 $67.33 N 29125 $67.33 N 29126 $67.33 N 29130 $67.33 N 29131 $67.33 N 29200 $67.33 N 29220 $67.33 N 29240 $67.33 N 29260 $67.33 N 29280 $67.33 N 29305 $141.12 N 29325 $141.12 N 29345 $141.12 N 29355 $141.12 N 29358 $141.12 N 29365 $141.12 N 29405 $141.12 N 29425 $141.12 N 29435 $141.12 N 29440 $67.33 N 29445 $141.12 N 29450 $67.33 N 29505 $67.33 N 29515 $67.33 N 29520 $67.33 N 29530 $67.33 N 29540 $67.33 N 29550 $67.33 N 29580 $67.33 N 29590 $67.33 N 29700 $67.33 N 29705 $67.33 N 29710 $141.12 N 29715 $67.33 N 29720 $67.33 N 29730 $67.33 N 29740 $67.33 N 29750 $67.33 N 29799 $67.33 N 29800 $1,772.80 Y 29804 $1,772.80 Y 29805 $1,772.80 Y 29806 $2,815.46 Y 29807 $2,815.46 Y 29819 $2,815.46 Y 29820 $2,815.46 Y 29821 $2,815.46 Y 29822 $1,772.80 Y 29823 $2,815.46 Y 29824 $1,772.80 Y 29825 $2,815.46 Y 29826 $2,815.46 Y 29827 $2,815.46 Y 29828 $2,815.46 Y 29830 $1,772.80 Y 29834 $1,772.80 Y 29835 $1,772.80 Y

25 UMP ASC Fee Schedule, Effective 01/01/09 29836 $1,772.80 Y 29837 $1,772.80 Y 29838 $1,772.80 Y 29840 $1,772.80 Y 29843 $1,772.80 Y 29844 $1,772.80 Y 29845 $1,772.80 Y 29846 $1,772.80 Y 29847 $2,815.46 Y 29848 $1,772.80 Y 29850 $1,772.80 Y 29851 $2,815.46 Y 29855 $2,815.46 Y 29856 $2,815.46 Y 29860 $2,815.46 Y 29861 $2,815.46 Y 29862 $2,815.46 Y 29863 $2,815.46 Y 29870 $1,772.80 Y 29871 $1,772.80 Y 29873 $1,772.80 Y 29874 $1,772.80 Y 29875 $1,772.80 Y 29876 $1,772.80 Y 29877 $1,772.80 Y 29879 $1,772.80 Y 29880 $1,772.80 Y 29881 $1,772.80 Y 29882 $1,772.80 Y 29883 $1,772.80 Y 29884 $1,772.80 Y 29885 $2,815.46 Y 29886 $1,772.80 Y 29887 $1,772.80 Y 29888 $2,815.46 Y 29889 $2,815.46 Y 29891 $2,815.46 Y 29892 $2,815.46 Y 29893 $1,282.98 Y 29894 $1,772.80 Y 29895 $1,772.80 Y 29897 $1,772.80 Y 29898 $1,772.80 Y 29899 $2,815.46 Y 29900 $1,772.80 Y 29901 $1,772.80 Y 29902 $1,772.80 Y 29904 $1,772.80 Y 29905 $1,772.80 Y 29906 $1,772.80 Y 29907 $2,815.46 Y 29999 $1,772.80 Y 30000 $154.01 Y 30020 $154.01 Y 30100 $458.74 Y 30110 $1,005.82 Y 30115 $1,005.82 Y 30117 $1,005.82 Y 30118 $1,476.90 Y 30120 $1,005.82 Y 30124 $458.74 Y 30125 $2,456.37 Y 30130 $1,005.82 Y 30140 $1,476.90 Y 30150 $2,456.37 Y 30160 $2,456.37 Y 30200 $458.74 Y 30210 $458.74 Y 30220 $458.74 Y 30300 $38.87 N 30310 $1,005.82 Y 30320 $1,005.82 Y 30400 $2,456.37 Y 30410 $2,456.37 Y 30420 $2,456.37 Y 30430 $1,476.90 Y 30435 $2,456.37 Y 30450 $2,456.37 Y 30460 $2,456.37 Y 30462 $2,456.37 Y 30465 $2,456.37 Y 30520 $1,476.90 Y 30540 $2,456.37 Y 30545 $2,456.37 Y 30560 $154.01 Y 30580 $2,456.37 Y 30600 $2,456.37 Y 30620 $2,456.37 Y 30630 $1,476.90 Y 30801 $458.74 Y 30802 $458.74 Y 30901 $69.30 Y 30903 $69.30 Y 30905 $69.30 Y 30906 $69.30 Y 30915 $1,591.75 Y 30920 $1,591.75 Y 30930 $1,005.82 Y 30999 $154.01 Y 31000 $154.01 Y 31002 $458.74 Y 31020 $1,476.90 Y 31030 $2,456.37 Y 31032 $2,456.37 Y

26 UMP ASC Fee Schedule, Effective 01/01/09 31040 $1,476.90 Y 31050 $2,456.37 Y 31051 $2,456.37 Y 31070 $1,476.90 Y 31075 $2,456.37 Y 31080 $2,456.37 Y 31081 $2,456.37 Y 31084 $2,456.37 Y 31085 $2,456.37 Y 31086 $2,456.37 Y 31087 $2,456.37 Y 31090 $2,456.37 Y 31200 $2,456.37 Y 31201 $2,456.37 Y 31205 $2,456.37 Y 31231 $99.26 Y 31233 $99.26 Y 31235 $1,048.15 Y 31237 $1,048.15 Y 31238 $1,048.15 Y 31239 $1,399.45 Y 31240 $1,048.15 Y 31254 $1,399.45 Y 31255 $1,399.45 Y 31256 $1,399.45 Y 31267 $1,399.45 Y 31276 $1,399.45 Y 31287 $1,399.45 Y 31288 $1,399.45 Y 31292 $1,399.45 Y 31293 $1,399.45 Y 31294 $1,399.45 Y 31299 $154.01 Y 31300 $1,476.90 Y 31320 $2,456.37 Y 31400 $2,456.37 Y 31420 $2,456.37 Y 31500 $151.47 N 31502 $82.31 N 31505 $50.66 Y 31510 $1,048.15 Y 31511 $99.26 Y 31512 $1,048.15 Y 31513 $99.26 Y 31515 $1,048.15 Y 31520 $99.26 Y 31525 $1,048.15 Y 31526 $1,399.45 Y 31527 $1,399.45 Y 31528 $1,048.15 Y 31529 $1,048.15 Y 31530 $1,399.45 Y 31531 $1,399.45 Y 31535 $1,399.45 Y 31536 $1,399.45 Y 31540 $1,399.45 Y 31541 $1,399.45 Y 31545 $1,399.45 Y 31546 $1,399.45 Y 31560 $1,399.45 Y 31561 $1,399.45 Y 31570 $1,048.15 Y 31571 $1,399.45 Y 31575 $99.26 Y 31576 $1,399.45 Y 31577 $246.02 Y 31578 $1,399.45 Y 31579 $246.02 Y 31580 $2,456.37 Y 31582 $2,456.37 Y 31588 $2,456.37 Y 31590 $2,456.37 Y 31595 $2,456.37 Y 31599 $154.01 Y 31600 $1,476.90 Y 31601 $1,476.90 Y 31603 $458.74 Y 31605 $458.74 Y 31610 $1,476.90 Y 31611 $1,476.90 Y 31612 $1,476.90 Y 31613 $1,476.90 Y 31614 $2,456.37 Y 31615 $613.36 Y 31620 $0.00 N 31622 $613.36 Y 31623 $613.36 Y 31624 $613.36 Y 31625 $613.36 Y 31628 $613.36 Y 31629 $613.36 Y 31630 $1,482.38 Y 31631 $1,482.38 Y 31632 $613.36 Y 31633 $613.36 Y 31635 $613.36 Y 31636 $1,482.38 Y 31637 $613.36 Y 31638 $1,482.38 Y 31640 $1,482.38 Y 31641 $1,482.38 Y 31643 $613.36 Y 31645 $613.36 Y 31646 $613.36 Y

27 UMP ASC Fee Schedule, Effective 01/01/09 31656 $613.36 Y 31715 $0.00 N 31717 $246.02 Y 31720 $23.88 N 31730 $246.02 Y 31750 $2,456.37 Y 31755 $2,456.37 Y 31785 $1,476.90 Y 31820 $1,005.82 Y 31825 $1,476.90 Y 31830 $1,476.90 Y 31899 $613.36 Y 32201 $320.46 Y 32400 $575.04 Y 32405 $575.04 Y 32420 $320.46 Y 32421 $320.46 Y 32422 $320.46 Y 32550 $1,891.64 Y 32551 $320.46 Y 32560 $320.46 Y 32601 $2,006.03 Y 32602 $2,006.03 Y 32603 $2,006.03 Y 32604 $2,006.03 Y 32605 $2,006.03 Y 32606 $2,006.03 Y 32960 $320.46 Y 32999 $320.46 Y 33010 $320.46 Y 33011 $320.46 Y 33206 $7,493.42 Y 33207 $7,493.42 Y 33208 $8,625.64 Y 33210 $4,282.38 Y 33211 $4,282.38 Y 33212 $6,211.16 Y 33213 $6,731.72 Y 33214 $8,625.64 Y 33215 $1,477.13 Y 33216 $4,282.38 Y 33217 $4,282.38 Y 33218 $1,477.13 Y 33220 $1,477.13 Y 33222 $926.79 Y 33223 $926.79 Y 33224 $15,999.94 Y 33225 $15,999.94 Y 33226 $1,477.13 Y 33233 $1,477.13 Y 33234 $1,477.13 Y 33235 $1,477.13 Y 33240 $20,561.94 Y 33241 $1,477.13 Y 33244 $1,477.13 Y 33249 $24,938.13 Y 33282 $4,349.25 N 33284 $534.98 Y 33508 $0.00 N 33999 $320.46 Y 34101 $2,387.98 Y 34111 $2,387.98 Y 34201 $2,387.98 Y 34203 $2,387.98 Y 34421 $2,387.98 Y 34471 $2,387.98 Y 34490 $2,387.98 Y 34501 $2,387.98 Y 34510 $2,387.98 Y 34520 $2,387.98 Y 34530 $2,387.98 Y 35011 $2,492.66 Y 35180 $1,855.90 Y 35184 $1,855.90 Y 35188 $2,387.98 Y 35190 $1,855.90 Y 35201 $1,855.90 Y 35206 $1,855.90 Y 35207 $2,387.98 Y 35226 $1,855.90 Y 35231 $1,855.90 Y 35236 $1,855.90 Y 35256 $1,855.90 Y 35261 $2,492.66 Y 35266 $2,492.66 Y 35286 $2,492.66 Y 35321 $1,855.90 Y 35458 $2,795.59 Y 35459 $2,795.59 Y 35460 $2,795.59 Y 35470 $2,795.59 Y 35471 $2,795.59 Y 35472 $2,795.59 Y 35473 $2,795.59 Y 35474 $2,795.59 Y 35475 $2,795.59 Y 35476 $2,795.59 Y 35484 $5,390.65 Y 35485 $5,390.65 Y 35490 $5,390.65 Y 35491 $5,390.65 Y 35492 $5,390.65 Y 35493 $5,390.65 Y 35494 $5,390.65 Y

28 UMP ASC Fee Schedule, Effective 01/01/09 35495 $5,390.65 Y 35500 $902.88 Y 35572 $0.00 N 35685 $1,855.90 Y 35686 $1,855.90 Y 35761 $1,829.24 Y 35860 $1,855.90 Y 35875 $2,387.98 Y 35876 $2,387.98 Y 35879 $2,387.98 Y 35881 $2,387.98 Y 35883 $2,387.98 Y 35884 $2,387.98 Y 35903 $1,829.24 Y 36000 $0.00 N 36002 $146.55 N 36005 $0.00 N 36010 $0.00 N 36011 $0.00 N 36012 $0.00 N 36013 $0.00 N 36014 $0.00 N 36015 $0.00 N 36100 $0.00 N 36120 $0.00 N 36140 $0.00 N 36145 $0.00 N 36160 $0.00 N 36200 $0.00 N 36215 $0.00 N 36216 $0.00 N 36217 $0.00 N 36218 $0.00 N 36245 $0.00 N 36246 $0.00 N 36247 $0.00 N 36248 $0.00 N 36260 $1,778.59 Y 36261 $1,477.13 Y 36262 $1,477.13 Y 36299 $0.00 N 36400 $0.00 N 36405 $0.00 N 36406 $0.00 N 36410 $0.00 N 36416 $0.00 N 36420 $13.20 Y 36425 $13.20 Y 36430 $209.23 N 36440 $209.23 N 36450 $209.23 N 36455 $209.23 N 36460 $209.23 N 36468 $48.85 Y 36469 $48.85 Y 36470 $48.85 Y 36471 $48.85 Y 36475 $2,624.77 Y 36476 $1,591.75 Y 36478 $1,591.75 Y 36479 $1,591.75 Y 36481 $0.00 N 36500 $0.00 N 36510 $0.00 N 36511 $708.73 N 36512 $708.73 N 36513 $708.73 N 36514 $708.73 N 36515 $1,885.11 N 36516 $1,885.11 N 36522 $1,885.11 N 36555 $671.98 Y 36556 $671.98 Y 36557 $1,484.93 Y 36558 $1,484.93 Y 36560 $1,778.59 Y 36561 $1,778.59 Y 36563 $1,778.59 Y 36565 $1,778.59 Y 36566 $5,035.51 Y 36568 $671.98 Y 36569 $671.98 Y 36570 $1,484.93 Y 36571 $1,484.93 Y 36575 $348.73 Y 36576 $671.98 Y 36578 $1,484.93 Y 36580 $671.98 Y 36581 $1,484.93 Y 36582 $1,778.59 Y 36583 $1,778.59 Y 36584 $671.98 Y 36585 $1,484.93 Y 36589 $348.73 Y 36590 $671.98 Y 36591 $0.00 N 36592 $0.00 N 36593 $152.91 Y 36595 $1,484.93 Y 36596 $671.98 Y 36597 $671.98 Y 36598 $152.91 Y 36600 $0.00 N 36620 $0.00 N