PENNSYLVANIA MEDICARE CARRIER - 12502 MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024 METROPOLITAN PHILADELPHIA ****** **A2001**1174.20*1115.49*1282.81 **A2002**180.18*171.17*196.85 **A2004**13.78*13.09*15.05 **A2005**267.80*254.41*292.57 **A2007**84.75*80.51*92.59 **A2008**92.91*88.26*101.50 **A2013**1313.25*1247.59*1434.73 **A2014**61.16*58.10*66.82 **A2015**1236.00*1174.20*1350.33 **A2019**580.92*551.87*634.65 **A2021**1387.93*1318.53*1516.31 **A2022**1339.00*1272.05*1462.86 **A2023**15.45*14.68*16.88 **A2024**2008.50*1908.08*2194.29 **A2025**257.50*244.63*281.32 **G0186**470.41*446.89*513.92 #**G0186**403.51*383.33*440.83 **G0339**2999.62*2849.64*3277.09 **G0340**2256.37*2143.55*2465.08 **G0398**140.07*133.07*153.03 **G0398*TC*100.76*95.72*110.08 **G0398*26*39.31*37.34*42.94 **G0399**96.90*92.06*105.87 **G0399*TC*53.52*50.84*58.47 **G0399*26*43.72*41.53*47.76 **G0400**100.08*95.08*109.34 **G0400*TC*59.39*56.42*64.88 **G0400*26*40.69*38.66*44.46 **G0460**824.12*782.91*900.35 #**G0460**123.84*117.65*135.30 **G0465**824.12*782.91*900.35 #**G0465**123.84*117.65*135.30 **G0498**152.48*144.86*166.59 **G6017**80.22*76.21*87.64 **0042T**233.96*222.26*255.60 **0054T**240.86*228.82*263.14 **0055T**240.86*228.82*263.14 **0071T**591.45*561.88*646.16 **0072T**591.45*561.88*646.16 **0075T**1002.45*952.33*1095.18 **0075T*TC*1002.45*952.33*1095.18 **0075T*26*1003.03*952.88*1095.81 **0076T**1114.14*1058.43*1217.19 **0076T*TC*891.32*846.75*973.76 **0076T*26*222.84*211.70*243.46 **0095T**658.00*625.10*718.87 **0098T**736.57*699.74*804.70 **0100T**1942.38*1845.26*2122.05 **0101T**322.40*306.28*352.22 #**0101T**231.02*219.47*252.39 **0102T**322.40*306.28*352.22 #**0102T**231.02*219.47*252.39 **0106T**34.86*33.12*38.09 **0107T**34.86*33.12*38.09 **0108T**34.86*33.12*38.09 **0109T**34.86*33.12*38.09 **0110T**34.86*33.12*38.09 **0164T**719.24*683.28*785.77 **0165T**736.93*700.08*805.09 **0174T**10.19*9.68*11.13 **0175T**3.02*2.87*3.30 **0184T**850.58*808.05*929.26 **0198T**87.43*83.06*95.52 #**0198T**32.26*30.65*35.25 **0200T**1836.53*1744.70*2006.41 #**0200T**413.90*393.21*452.19 **0201T**2754.79*2617.05*3009.61 #**0201T**620.85*589.81*678.28 **0207T**121.70*115.62*132.96 **0208T**39.35*37.38*42.99 **0209T**47.62*45.24*52.03 **0210T**30.04*28.54*32.82 **0211T**46.59*44.26*50.90 **0212T**37.09*35.24*40.53 #**0212T**31.92*30.32*34.87 **0213T**198.64*188.71*217.02 #**0213T**107.27*101.91*117.20 **0214T**100.07*95.07*109.33 #**0214T**60.07*57.07*65.63 **0215T**100.41*95.39*109.70 #**0215T**61.10*58.05*66.76 **0216T**182.94*173.79*199.86 #**0216T**92.26*87.65*100.80 **0217T**93.59*88.91*102.25 #**0217T**51.52*48.94*56.28 **0218T**93.59*88.91*102.25 #**0218T**52.56*49.93*57.42 **0219T**1377.17*1308.31*1504.56 **0220T**1351.68*1284.10*1476.72 **0221T**1652.80*1570.16*1805.68 **0222T**405.75*385.46*443.28 **0232T**824.12*782.91*900.35 #**0232T**123.84*117.65*135.30 **0234T**8850.42*8407.90*9669.09 #**0234T**599.45*569.48*654.90 **0235T**8850.42*8407.90*9669.09 #**0235T**599.45*569.48*654.90 **0236T**9004.31*8554.09*9837.20 #**0236T**692.99*658.34*757.09 **0237T**9004.31*8554.09*9837.20 #**0237T**692.99*658.34*757.09 **0238T**9004.31*8554.09*9837.20 #**0238T**692.99*658.34*757.09 **0253T**940.06*893.06*1027.02 **0266T**925.42*879.15*1011.02 **0267T**162.41*154.29*177.43 **0268T**344.70*327.47*376.59 **0269T**876.95*833.10*958.07 **0270T**162.41*154.29*177.43 **0271T**344.70*327.47*376.59 **0272T**57.60*54.72*62.93 **0273T**73.58*69.90*80.39 **0274T**1157.32*1099.45*1264.37 **0278T**14.63*13.90*15.99 **0308T**1426.04*1354.74*1557.95 **0329T**87.43*83.06*95.52 #**0329T**32.26*30.65*35.25 **0330T**38.21*36.30*41.75 **0331T**189.16*179.70*206.66 **0332T**322.86*306.72*352.73 **0347T**145.81*138.52*159.30 **0348T**34.03*32.33*37.18 **0349T**36.11*34.30*39.45 **0350T**36.80*34.96*40.20 **0351T**174.90*166.16*191.08 **0352T**43.50*41.33*47.53 **0353T**174.90*166.16*191.08 **0354T**43.50*41.33*47.53 **0358T**27.97*26.57*30.56 **0362T**93.30*88.64*101.94 #**0362T**66.75*63.41*72.92 **0378T**25.18*23.92*27.51 **0394T**257.97*245.07*281.83 **0395T**623.98*592.78*681.70 **0397T**47.61*45.23*52.01 **0398T*26*1718.37*1632.45*1877.32 **0403T**26.95*25.60*29.44 **0408T**525.56*499.28*574.17 **0409T**363.91*345.71*397.57 **0410T**378.41*359.49*413.41 **0411T**378.41*359.49*413.41 **0412T**238.54*226.61*260.60 **0413T**492.12*467.51*537.64 **0414T**379.48*360.51*414.59 **0415T**316.09*300.29*345.33 **0416T**350.94*333.39*383.40 **0417T**85.55*81.27*93.46 **0418T**57.60*54.72*62.93 **0419T**462.73*439.59*505.53 #**0419T**370.33*351.81*404.58 **0420T**658.04*625.14*718.91 #**0420T**543.92*516.72*594.23 **0421T**1656.78*1573.94*1810.03 #**0421T**708.93*673.48*774.50 **0437T**219.05*208.10*239.32 **0439T**74.31*70.59*81.18 **0440T**256.19*243.38*279.89 #**0440T**121.72*115.63*132.97 **0441T**256.19*243.38*279.89 #**0441T**121.72*115.63*132.97 **0442T**256.19*243.38*279.89 #**0442T**121.72*115.63*132.97 **0449T**779.27*740.31*851.36 **0464T**69.40*65.93*75.82 **0472T**68.81*65.37*75.18 **0473T**57.60*54.72*62.93 **0479T**63.93*60.73*69.84 **0480T**80.07*76.07*87.48 #**0480T**31.97*30.37*34.93 **0483T**1221.21*1160.15*1334.17 **0484T**1582.96*1503.81*1729.38 **0485T**24.09*22.89*26.32 **0485T*TC*9.18*8.72*10.03 **0485T*26*15.30*14.54*16.72 **0486T**48.18*45.77*52.64 **0486T*TC*17.97*17.07*19.63 **0486T*26*30.21*28.70*33.01 **0488T**64.16*60.95*70.09 #**0488T**50.71*48.17*55.40 **0505T**11770.26*11181.75*12859.01 #**0505T**602.66*572.53*658.41 **0507T**24.17*22.96*26.40 **0507T*TC*21.07*20.02*23.02 **0507T*26*3.10*2.95*3.39 **0510T**623.07*591.92*680.71 #**0510T**436.88*415.04*477.30 **0512T**322.40*306.28*352.22 #**0512T**231.02*219.47*252.39 **0513T**96.72*91.88*105.66 #**0513T**69.31*65.84*75.72 **0515T**525.56*499.28*574.17 **0516T**485.25*460.99*530.14 **0517T**344.70*327.47*376.59 **0518T**238.54*226.61*260.60 **0519T**345.76*328.47*377.74 **0520T**485.25*460.99*530.14 **0521T**57.60*54.72*62.93 **0521T*TC*37.28*35.42*40.73 **0521T*26*20.32*19.30*22.20 **0522T**68.81*65.37*75.18 **0522T*TC*37.97*36.07*41.48 **0522T*26*30.84*29.30*33.70 **0523T**156.92*149.07*171.43 **0524T**1698.41*1613.49*1855.51 #**0524T**180.96*171.91*197.70 **0525T**485.60*461.32*530.52 **0526T**378.41*359.49*413.41 **0527T**329.19*312.73*359.64 **0528T**68.81*65.37*75.18 **0528T*TC*37.97*36.07*41.48 **0528T*26*30.84*29.30*33.70 **0529T**57.60*54.72*62.93 **0529T*TC*37.28*35.42*40.73 **0529T*26*20.32*19.30*22.20 **0530T**646.96*614.61*706.80 **0531T**492.12*467.51*537.64 **0532T**345.76*328.47*377.74 **0540T**180.36*171.34*197.04 **0543T**1582.96*1503.81*1729.38 **0544T**1821.41*1730.34*1989.89 **0545T**1821.41*1730.34*1989.89 **0546T**73.50*69.83*80.30 **0552T**6.88*6.54*7.52 **0553T**2538.99*2412.04*2773.85 #**0553T**400.91*380.86*437.99 **0565T**634.14*602.43*692.79 #**0565T**531.05*504.50*580.18 **0566T**102.66*97.53*112.16 #**0566T**60.25*57.24*65.83 **0569T**1821.41*1730.34*1989.89 **0570T**426.68*405.35*466.15 **0571T**568.64*540.21*621.24 **0572T**462.92*439.77*505.74 **0573T**353.65*335.97*386.37 **0574T**409.92*389.42*447.83 **0575T**68.81*65.37*75.18 **0576T**57.60*54.72*62.93 **0577T**193.71*184.02*211.62 **0578T**29.59*28.11*32.33 **0579T**22.11*21.00*24.15 **0580T**219.59*208.61*239.90 **0581T**2345.31*2228.04*2562.25 #**0581T**216.54*205.71*236.57 **0582T**1710.63*1625.10*1868.87 #**0582T**393.16*373.50*429.53 **0583T**1496.16*1421.35*1634.55 #**0583T**137.05*130.20*149.73 **0587T**455.67*432.89*497.82 #**0587T**302.58*287.45*330.57 **0588T**375.88*357.09*410.65 #**0588T**236.24*224.43*258.09 **0589T**49.19*46.73*53.74 #**0589T**39.20*37.24*42.83 **0590T**58.18*55.27*63.56 #**0590T**40.60*38.57*44.36 **0596T**2235.23*2123.47*2441.99 #**0596T**132.28*125.67*144.52 **0597T**672.69*639.06*734.92 #**0597T**132.28*125.67*144.52 **0598T**156.37*148.55*170.83 **0599T**103.93*98.73*113.54 **0600T**3690.14*3505.63*4031.47 #**0600T**733.86*697.17*801.75 **0601T**1496.52*1421.69*1634.94 **0607T**19.36*18.39*21.15 **0608T**1217.40*1156.53*1330.01 **0609T**201.74*191.65*220.40 **0611T**42.15*40.04*46.05 **0614T**378.77*359.83*413.80 **0615T**48.10*45.70*52.56 **0616T**674.94*641.19*737.37 **0617T**755.82*718.03*825.73 **0618T**915.28*869.52*999.95 **0619T**671.30*637.74*733.40 #**0619T**487.57*463.19*532.67 **0620T**1414.22*1343.51*1545.04 **0623T**1600.00*1520.00*1748.00 **0624T**25.00*23.75*27.31 **0625T**1500.00*1425.00*1638.75 **0626T**75.00*71.25*81.94 **0627T**266.58*253.25*291.24 #**0627T**101.08*96.03*110.43 **0628T**79.98*75.98*87.38 #**0628T**30.32*28.80*33.12 **0629T**266.58*253.25*291.24 #**0629T**101.08*96.03*110.43 **0630T**79.98*75.98*87.38 #**0630T**30.32*28.80*33.12 **0631T**85.13*80.87*93.00 **0632T**585.85*556.56*640.04 **0633T**207.39*197.02*226.57 *C*0633T*TC*110.38*104.86*120.59 **0633T*26*59.40*56.43*64.89 **0634T**207.39*197.02*226.57 **0634T*TC*148.00*140.60*161.69 **0634T*26*59.40*56.43*64.89 **0635T**207.39*197.02*226.57 **0635T*TC*148.00*140.60*161.69 **0635T*26*59.40*56.43*64.89 **0636T**207.39*197.02*226.57 **0636T*TC*148.00*140.60*161.69 **0636T*26*59.40*56.43*64.89 **0637T**207.39*197.02*226.57 **0637T*TC*148.00*140.60*161.69 **0637T*26*59.40*56.43*64.89 **0638T**207.39*197.02*226.57 **0638T*TC*148.00*140.60*161.69 **0638T*26*59.40*56.43*64.89 **0639T**85.13*80.87*93.00 **0640T**24.17*22.96*26.40 **0640T*TC*21.07*20.02*23.02 **0640T*26*3.10*2.95*3.39 **0644T**1200.35*1140.33*1311.38 #**0644T**244.23*232.02*266.82 **0646T**1821.41*1730.34*1989.89 **0648T**350.51*332.98*382.93 **0648T*TC*235.45*223.68*257.23 **0648T*26*115.06*109.31*125.71 **0650T**61.35*58.28*67.02 **0652T**296.63*281.80*324.07 #**0652T**124.23*118.02*135.72 **0653T**387.88*368.49*423.76 #**0653T**140.32*133.30*153.30 **0654T**144.13*136.92*157.46 **0655T**1656.78*1573.94*1810.03 #**0655T**708.93*673.48*774.50 **0658T**98.31*93.39*107.40 **0659T**2781.61*2642.53*3038.91 #**0659T**442.16*420.05*483.06 **0671T**1047.50*995.13*1144.40 **0673T**3546.02*3368.72*3874.03 #**0673T**370.79*352.25*405.09 **0699T**115.28*109.52*125.95 #**0699T**92.52*87.89*101.07 **0707T**383.18*364.02*418.62 #**0707T**287.68*273.30*314.30 **0714T**1451.88*1379.29*1586.18 #**0714T**367.15*348.79*401.11 **0730T**280.75*266.71*306.72 #**0730T**251.14*238.58*274.37 **0738T**71.84*68.25*78.49 **0739T**1656.78*1573.94*1810.03 #**0739T**708.93*673.48*774.50 **0740T**20.77*19.73*22.69 **0741T**49.00*46.55*53.53 **0742T**96.86*92.02*105.82 **0742T*TC*77.64*73.76*84.82 **0742T*26*19.22*18.26*21.00 **0743T**55.00*52.25*60.09 **0744T**908.86*863.42*992.93 **0745T**266.47*253.15*291.12 **0746T**227.67*216.29*248.73 **0747T**1030.23*978.72*1125.53 **0748T**188.50*179.08*205.94 **0751T**9.43*8.96*10.30 **0752T**12.24*11.63*13.37 **0753T**20.66*19.63*22.57 **0754T**83.17*79.01*90.86 **0755T**446.94*424.59*488.28 **0756T**115.08*109.33*125.73 **0757T**83.98*79.78*91.75 **0758T**92.75*88.11*101.33 **0759T**138.92*131.97*151.77 **0760T**102.17*97.06*111.62 **0761T**0.01*0.01*0.01 **0762T**0.01*0.01*0.01 **0763T**120.64*114.61*131.80 **0764T**4.42*4.20*4.83 **0765T**8.15*7.74*8.90 **0771T**26.83*25.49*29.31 **0772T**26.83*25.49*29.31 **0773T**24.01*22.81*26.23 **0774T**24.01*22.81*26.23 **0777T**325.00*308.75*355.06 #**0777T**25.00*23.75*27.31 **0777T*TC*276.25*262.44*301.81 #**0777T*TC*21.25*20.19*23.22 **0777T*26*45.75*43.46*49.98 #**0777T*26*3.75*3.56*4.09 **0779T**452.00*429.40*493.81 **0779T*TC*425.86*404.57*465.26 **0779T*26*26.14*24.83*28.55 **0780T**24.01*22.81*26.23 **0783T**14.87*14.13*16.25 **0784T**2192.02*2082.42*2394.78 #**0784T**330.81*314.27*361.41 **0785T**250.23*237.72*273.38 #**0785T**148.51*141.08*162.24 **0786T**756.39*718.57*826.36 #**0786T**310.22*294.71*338.92 **0787T**250.23*237.72*273.38 #**0787T**148.51*141.08*162.24 **0788T**19.10*18.15*20.87 #**0788T**18.41*17.49*20.11 **0789T**27.05*25.70*29.56 #**0789T**23.01*21.86*25.14 **0790T**1957.21*1859.35*2138.25 **0791T**9.26*8.80*10.12 **0793T**585.85*556.56*640.04 **0794T**130.35*123.83*142.40 **0795T**727.88*691.49*795.21 **0796T**485.25*460.99*530.14 **0797T**485.25*460.99*530.14 **0798T**769.47*731.00*840.65 **0799T**512.98*487.33*560.43 **0800T**512.98*487.33*560.43 **0801T**998.23*948.32*1090.57 **0802T**499.12*474.16*545.28 **0803T**499.12*474.16*545.28 **0804T**80.42*76.40*87.86 **0804T*TC*43.83*41.64*47.89 **0804T*26*36.59*34.76*39.97 **0805T**3059.28*2906.32*3342.27 #**0805T**329.52*313.04*360.00 **0806T**4079.04*3875.09*4456.35 #**0806T**439.36*417.39*480.00 **0807T**44.01*41.81*48.08 **0807T*TC*29.00*27.55*31.68 **0807T*26*15.01*14.26*16.40 **0808T**44.01*41.81*48.08 **0808T*TC*29.00*27.55*31.68 **0808T*26*15.01*14.26*16.40 **0810T**1155.45*1097.68*1262.33 **0811T**20.77*19.73*22.69 **0813T**2689.26*2554.80*2938.02 #**0813T**185.35*176.08*202.49 **0814T**478.98*455.03*523.28 #**0814T**359.59*341.61*392.85 **0818T**375.88*357.09*410.65 #**0818T**236.24*224.43*258.09 **0820T**149.00*141.55*162.78 #**0820T**130.73*124.19*142.82 **0821T**149.00*141.55*162.78 #**0821T**130.73*124.19*142.82 **0822T**126.65*120.32*138.37 #**0822T**111.12*105.56*121.39 **0823T**727.88*691.49*795.21 **0824T**769.47*731.00*840.65 **0825T**998.23*948.32*1090.57 **0826T**68.81*65.37*75.18 **0826T*TC*37.97*36.07*41.48 **0826T*26*30.84*29.30*33.70 **0827T**0.01*0.01*0.01 **0828T**0.01*0.01*0.01 **0829T**0.01*0.01*0.01 **0830T**0.01*0.01*0.01 **0831T**0.01*0.01*0.01 **0832T**0.01*0.01*0.01 **0833T**0.01*0.01*0.01 **0834T**0.01*0.01*0.01 **0835T**0.01*0.01*0.01 **0836T**0.01*0.01*0.01 **0837T**0.01*0.01*0.01 **0838T**0.01*0.01*0.01 **0839T**0.01*0.01*0.01 **0840T**0.01*0.01*0.01 **0841T**0.01*0.01*0.01 **0842T**0.01*0.01*0.01 **0843T**0.01*0.01*0.01 **0844T**0.01*0.01*0.01 **0845T**0.01*0.01*0.01 **0846T**0.01*0.01*0.01 **0847T**0.01*0.01*0.01 **0848T**0.01*0.01*0.01 **0849T**0.01*0.01*0.01 **0850T**0.01*0.01*0.01 **0851T**0.01*0.01*0.01 **0852T**0.01*0.01*0.01 **0853T**0.01*0.01*0.01 **0854T**0.01*0.01*0.01 **0855T**0.01*0.01*0.01 **0856T**0.01*0.01*0.01 **0859T**24.17*22.96*26.40 **0859T*TC*21.07*20.02*23.02 **0859T*26*3.10*2.95*3.39 **0864T**322.40*306.28*352.22 #**0864T**231.02*219.47*252.39 **10011**439.74*417.75*480.41 #**10011**109.08*103.63*119.17 **10012**242.37*230.25*264.79 #**10012**72.73*69.09*79.45 **15847**363.24*345.08*396.84 **21088**1692.77*1608.13*1849.35 **21742**1189.01*1129.56*1298.99 **21743**1369.23*1300.77*1495.89 **24940**1715.39*1629.62*1874.06 **32855**525.08*498.83*573.65 **32856**464.76*441.52*507.75 **33928**3398.79*3228.85*3713.18 **33929**1272.83*1209.19*1390.57 **33933**608.16*577.75*664.41 **33944**595.10*565.35*650.15 **34841**2301.94*2186.84*2514.87 **34842**2527.69*2401.31*2761.51 **34843**2753.47*2615.80*3008.17 **34844**2979.26*2830.30*3254.85 **34845**2301.94*2186.84*2514.87 **34846**2527.69*2401.31*2761.51 **34847**2753.47*2615.80*3008.17 **34848**2979.26*2830.30*3254.85 **43496**2337.42*2220.55*2553.63 **43647**808.32*767.90*883.09 **43648**581.29*552.23*635.06 #**43648**259.83*246.84*283.87 **43881**776.25*737.44*848.06 #**43881**715.99*680.19*782.22 **43882**819.77*778.78*895.60 #**43882**754.88*717.14*824.71 **44137**1815.97*1725.17*1983.95 **44715**414.85*394.11*453.23 **47143**459.08*436.13*501.55 **47144**545.13*517.87*595.55 **47145**516.45*490.63*564.22 **48551**525.08*498.83*573.65 **49906**2241.55*2129.47*2448.89 **50323**705.70*670.42*770.98 **50325**351.94*334.34*384.49 **53451**775.42*736.65*847.15 **53452**387.71*368.32*423.57 **53453**659.09*626.14*720.06 **53454**58.19*55.28*63.57 #**53454**35.78*33.99*39.09 **54440**819.14*778.18*894.91 **63043**605.08*574.83*661.05 **63044**594.60*564.87*649.60 **64596**2192.02*2082.42*2394.78 #**64596**330.81*314.27*361.41 **64597**657.61*624.73*718.44 #**64597**99.24*94.28*108.42 **64598**250.23*237.72*273.38 #**64598**148.51*141.08*162.24 **65757**122.73*116.59*134.08 **66983**674.94*641.19*737.37 **66987**779.92*740.92*852.06 **66988**647.72*615.33*707.63 *C*70170**260.50*247.48*284.60 *C*70170*TC*245.88*233.59*268.63 **70555**233.47*221.80*255.07 **70555*TC*114.72*108.98*125.33 *C*70557**706.37*671.05*771.71 *C*70557*TC*553.44*525.77*604.64 *C*70558**353.06*335.41*385.72 *C*70558*TC*184.51*175.28*201.57 *C*70559**343.20*326.04*374.95 *C*70559*TC*184.51*175.28*201.57 *C*74190**575.52*546.74*628.75 *C*74190*TC*553.44*525.77*604.64 **74235**151.35*143.78*165.35 **74235*TC*94.66*89.93*103.42 **74300**87.73*83.34*95.84 **74300*TC*74.46*70.74*81.35 **74301**27.13*25.77*29.64 **74301*TC*17.29*16.43*18.89 **74328**175.06*166.31*191.26 **74328*TC*151.98*144.38*166.04 **74329**147.70*140.32*161.37 **74329*TC*124.27*118.06*135.77 **74330**262.59*249.46*286.88 **74330*TC*235.42*223.65*257.20 **74340**86.58*82.25*94.59 **74340*TC*61.11*58.05*66.76 **74355**86.58*82.25*94.59 **74355*TC*50.25*47.74*54.90 **74360**86.58*82.25*94.59 **74360*TC*59.31*56.34*64.79 **74363**175.06*166.31*191.26 **74363*TC*133.63*126.95*145.99 *C*74445**163.93*155.73*179.09 *C*74445*TC*110.38*104.86*120.59 *C*74450**261.47*248.40*285.66 *C*74450*TC*245.88*233.59*268.63 *C*74470**578.22*549.31*631.71 *C*74470*TC*553.44*525.77*604.64 **74742**233.47*221.80*255.07 **74742*TC*204.27*194.06*223.17 *C*74775**275.41*261.64*300.89 *C*74775*TC*245.88*233.59*268.63 *C*75801**673.53*639.85*735.83 *C*75801*TC*630.33*598.81*688.63 *C*75803**1662.82*1579.68*1816.63 *C*75803*TC*1606.79*1526.45*1755.42 *C*75805**3236.73*3074.89*3536.12 *C*75805*TC*3198.03*3038.13*3493.85 *C*75807**3250.68*3088.15*3551.37 *C*75807*TC*3198.03*3038.13*3493.85 *C*75810**3246.31*3083.99*3546.59 *C*75810*TC*3198.03*3038.13*3493.85 **75894**945.14*897.88*1032.56 **75894*TC*872.54*828.91*953.25 *C*75898**3290.67*3126.14*3595.06 *C*75898*TC*3198.03*3038.13*3493.85 **75970**461.05*438.00*503.70 **75970*TC*423.32*402.15*462.47 **76125**41.35*39.28*45.17 **76125*TC*28.08*26.68*30.68 **76390**213.02*202.37*232.73 **76390*TC*160.41*152.39*175.25 **76390*26*52.61*49.98*57.48 **76932**88.10*83.70*96.26 **76932*TC*51.82*49.23*56.61 **76940**164.94*156.69*180.19 **76940*TC*63.68*60.50*69.58 **76941**119.63*113.65*130.70 **76941*TC*55.61*52.83*60.75 **76945**87.02*82.67*95.07 **76945*TC*55.20*52.44*60.31 *C*76975**286.61*272.28*313.12 *C*76975*TC*245.88*233.59*268.63 **76998**175.06*166.31*191.26 **76998*TC*127.69*121.31*139.51 **77013**438.81*416.87*479.40 **77013*TC*256.43*243.61*280.15 **77022**489.06*464.61*534.30 **77022*TC*290.14*275.63*316.97 **77371**1399.17*1329.21*1528.59 **77520**947.73*900.34*1035.39 **77522**947.73*900.34*1035.39 **77523**1088.05*1033.65*1188.70 **77525**1228.35*1166.93*1341.97 *C*78282**428.99*407.54*468.67 *C*78282*TC*413.80*393.11*452.08 **78414**514.99*489.24*562.63 **78414*TC*494.00*469.30*539.70 *C*78429**1648.12*1565.71*1800.57 *C*78429*TC*1569.55*1491.07*1714.73 *C*78430**1644.37*1562.15*1796.47 *C*78430*TC*1569.55*1491.07*1714.73 *C*78431**2457.22*2334.36*2684.51 *C*78431*TC*2369.83*2251.34*2589.04 *C*78432**2041.97*1939.87*2230.85 *C*78432*TC*1948.49*1851.07*2128.73 *C*78433**2156.30*2048.49*2355.76 *C*78433*TC*2053.99*1951.29*2243.98 **78434**737.17*700.31*805.36 **78434*TC*708.38*672.96*773.90 *C*78459**1497.59*1422.71*1636.12 *C*78459*TC*1424.74*1353.50*1556.53 *C*78491**1641.03*1558.98*1792.83 *C*78491*TC*1569.55*1491.07*1714.73 *C*78492**1653.60*1570.92*1806.56 *C*78492*TC*1569.55*1491.07*1714.73 *C*78608**1638.37*1556.45*1789.92 *C*78608*TC*1569.55*1491.07*1714.73 *C*78811**1495.62*1420.84*1633.97 *C*78811*TC*1424.74*1353.50*1556.53 *C*78812**1659.11*1576.15*1812.57 *C*78812*TC*1569.55*1491.07*1714.73 *C*78813**1661.12*1578.06*1814.77 *C*78813*TC*1569.55*1491.07*1714.73 *C*78814**1670.97*1587.42*1825.53 *C*78814*TC*1569.55*1491.07*1714.73 *C*78815**1682.50*1598.38*1838.14 *C*78815*TC*1569.55*1491.07*1714.73 *C*78816**1683.44*1599.27*1839.16 *C*78816*TC*1569.55*1491.07*1714.73 **79300**237.04*225.19*258.97 **79300*TC*174.00*165.30*190.10 **79445**237.04*225.19*258.97 **79445*TC*128.07*121.67*139.92 **86485**6.76*6.42*7.38 **90867**309.35*293.88*337.96 #**90867**140.23*133.22*153.20 **90868**206.96*196.61*226.10 #**90868**106.40*101.08*116.24 **90869**284.40*270.18*310.71 #**90869**164.90*156.66*180.16 **90952**510.97*485.42*558.23 **90953**364.94*346.69*398.69 **92978**253.91*241.21*277.39 **92978*TC*159.07*151.12*173.79 **92979**153.83*146.14*168.06 **92979*TC*78.63*74.70*85.91 *C*93315**678.48*644.56*741.24 *C*93315*TC*553.44*525.77*604.64 **93317**221.47*210.40*241.96 **93317*TC*134.12*127.41*146.52 *C*93318**654.29*621.58*714.82 *C*93318*TC*553.44*525.77*604.64 **93571**252.88*240.24*276.28 **93571*TC*180.77*171.73*197.49 **93572**151.37*143.80*165.37 **93572*TC*98.79*93.85*107.93 **93600**3557.81*3379.92*3886.91 **93600*TC*3441.66*3269.58*3760.02 **93602**3557.81*3379.92*3886.91 **93602*TC*3443.81*3271.62*3762.36 **93603**3557.81*3379.92*3886.91 **93603*TC*3443.81*3271.62*3762.36 **93609**2134.69*2027.96*2332.15 **93609*TC*1862.19*1769.08*2034.44 **93610**3557.81*3379.92*3886.91 **93610*TC*3396.78*3226.94*3710.98 **93612**3557.81*3379.92*3886.91 **93612*TC*3399.31*3229.34*3713.74 **93615**50.55*48.02*55.22 **93615*TC*14.97*14.22*16.35 **93616**84.64*80.41*92.47 **93616*TC*27.04*25.69*29.54 **93619**7115.62*6759.84*7773.82 **93619*TC*6730.75*6394.21*7353.34 **93620**7115.62*6759.84*7773.82 **93620*TC*6498.04*6173.14*7099.11 **93621**7115.62*6759.84*7773.82 **93621*TC*7033.46*6681.79*7684.06 **93622**7115.62*6759.84*7773.82 **93622*TC*6946.18*6598.87*7588.70 **93623**2134.69*2027.96*2332.15 **93623*TC*2072.26*1968.65*2263.95 **93624**3557.81*3379.92*3886.91 **93624*TC*3318.23*3152.32*3625.17 **93631**7115.62*6759.84*7773.82 **93631*TC*6720.40*6384.38*7342.04 **93640**1133.95*1077.25*1238.84 **93640*TC*957.69*909.81*1046.28 **93641**1133.95*1077.25*1238.84 **93641*TC*825.59*784.31*901.96 **93662**443.95*421.75*485.01 **93662*TC*374.47*355.75*409.11 **93745**111.46*105.89*121.77 **93745*TC*83.60*79.42*91.33 **93745*26*27.86*26.47*30.44 **94642**38.57*36.64*42.14 **94772**324.24*308.03*354.23 **94772*TC*201.05*191.00*219.65 **94772*26*123.19*117.03*134.58 **95700**259.12*246.16*283.08 **95705**103.65*98.47*113.24 **95706**431.17*409.61*471.05 **95707**538.96*512.01*588.81 **95708**155.47*147.70*169.86 **95709**861.30*818.24*940.98 **95710**1076.88*1023.04*1176.50 **95711**129.56*123.08*141.54 **95712**518.23*492.32*566.17 **95713**647.79*615.40*707.71 **95714**207.29*196.93*226.47 **95715**1036.46*984.64*1132.34 **95716**1295.58*1230.80*1415.42 **95824**67.56*64.18*73.81 **95824*TC*28.83*27.39*31.50 **95965**946.80*899.46*1034.38 **95965*TC*536.80*509.96*586.45 **96020**404.66*384.43*442.09 **96020*TC*248.05*235.65*271.00 **96547**770.21*731.70*841.46 #**96547**136.82*129.98*149.48 **96548**385.10*365.85*420.73 #**96548**68.41*64.99*74.74 **97039**16.66*15.83*18.20 **97139**22.56*21.43*24.64 **97151**50.30*47.79*54.96 #**97151**44.44*42.22*48.55 **97152**42.75*40.61*46.70 #**97152**37.77*35.88*41.26 **97153**34.01*32.31*37.16 #**97153**29.70*28.22*32.45 **97154**4.69*4.46*5.13 #**97154**4.25*4.04*4.65 **97155**34.01*32.31*37.16 #**97155**29.70*28.22*32.45 **97156**35.86*34.07*39.18 #**97156**31.38*29.81*34.28 **97157**10.52*9.99*11.49 #**97157**9.49*9.02*10.37 **97158**5.45*5.18*5.96 #**97158**4.94*4.69*5.39 **98978**49.00*46.55*53.53 # - THESE AMOUNTS APPLY WHEN SERVICE IS PERFORMED IN A FACILITY SETTING. C - THE PAYMENT FOR THE TECHNICAL COMPONENT IS CAPPED AT THE OPPS AMOUNT. LC (LIMITING CHARGE) APPLIES TO UNASSIGNED CLAIMS BY NON-PARTICIPATING PROVIDERS. SOME CODES ARE CARRIER PRICED & SUBJECT TO CHANGE. OUR FEE LOOKUP TOOL HAS CURRENT PRICING. ALL CURRENT PROCEDURAL TERMINOLOGY (CPT) CODES AND DESCRIPTORS ARE COPYRIGHTED 2023 BY THE AMERICAN MEDICAL ASSOCIATION.