PENNSYLVANIA MEDICARE CARRIER - 12502
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
REST OF STATE
******
**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**426.59*405.26*466.05
#**G0186**367.71*349.32*401.72
**G0339**2585.37*2456.10*2824.52
**G0340**1944.59*1847.36*2124.46
**G0398**125.87*119.58*137.52
**G0398*TC*88.63*84.20*96.83
**G0398*26*37.24*35.38*40.69
**G0399**88.12*83.71*96.27
**G0399*TC*47.05*44.70*51.41
**G0399*26*41.38*39.31*45.21
**G0400**90.66*86.13*99.05
**G0400*TC*52.21*49.60*57.04
**G0400*26*38.45*36.53*42.01
**G0460**731.42*694.85*799.08
#**G0460**114.93*109.18*125.56
**G0465**731.42*694.85*799.08
#**G0465**114.93*109.18*125.56
**G0498**134.66*127.93*147.12
**G6017**72.91*69.26*79.65
**0042T**211.90*201.31*231.51
**0054T**219.23*208.27*239.51
**0055T**219.23*208.27*239.51
**0071T**543.89*516.70*594.21
**0072T**543.89*516.70*594.21
**0075T**923.60*877.42*1009.03
**0075T*TC*923.60*877.42*1009.03
**0075T*26*923.60*877.42*1009.03
**0076T**1033.83*982.14*1129.46
**0076T*TC*827.05*785.70*903.56
**0076T*26*206.77*196.43*225.89
**0095T**594.35*564.63*649.32
**0098T**665.54*632.26*727.10
**0100T**1790.56*1701.03*1956.18
**0101T**293.86*279.17*321.05
#**0101T**213.42*202.75*233.16
**0102T**293.86*279.17*321.05
#**0102T**213.42*202.75*233.16
**0106T**30.78*29.24*33.63
**0107T**30.78*29.24*33.63
**0108T**30.78*29.24*33.63
**0109T**30.78*29.24*33.63
**0110T**30.78*29.24*33.63
**0164T**649.47*617.00*709.55
**0165T**665.48*632.21*727.04
**0174T**9.55*9.07*10.43
**0175T**2.65*2.52*2.90
**0184T**780.11*741.10*852.27
**0198T**78.86*74.92*86.16
#**0198T**30.29*28.78*33.10
**0200T**1636.53*1554.70*1787.91
#**0200T**384.13*364.92*419.66
**0201T**2454.79*2332.05*2681.86
#**0201T**576.19*547.38*629.49
**0207T**121.70*115.62*132.96
**0208T**34.60*32.87*37.80
**0209T**41.89*39.80*45.77
**0210T**26.41*25.09*28.85
**0211T**40.98*38.93*44.77
**0212T**34.52*32.79*37.71
#**0212T**29.97*28.47*32.74
**0213T**180.09*171.09*196.75
#**0213T**99.65*94.67*108.87
**0214T**91.40*86.83*99.85
#**0214T**56.19*53.38*61.39
**0215T**91.70*87.12*100.19
#**0215T**57.10*54.25*62.39
**0216T**165.41*157.14*180.71
#**0216T**85.58*81.30*93.50
**0217T**85.25*80.99*93.14
#**0217T**48.22*45.81*52.68
**0218T**85.25*80.99*93.14
#**0218T**49.13*46.67*53.67
**0219T**1246.24*1183.93*1361.52
**0220T**1224.73*1163.49*1338.01
**0221T**1506.41*1431.09*1645.75
**0222T**370.37*351.85*404.63
**0232T**731.42*694.85*799.08
#**0232T**114.93*109.18*125.56
**0234T**7820.06*7429.06*8543.42
#**0234T**556.38*528.56*607.84
**0235T**7820.06*7429.06*8543.42
#**0235T**556.38*528.56*607.84
**0236T**7961.24*7563.18*8697.66
#**0236T**644.43*612.21*704.04
**0237T**7961.24*7563.18*8697.66
#**0237T**644.43*612.21*704.04
**0238T**7961.24*7563.18*8697.66
#**0238T**644.43*612.21*704.04
**0253T**818.50*777.58*894.22
**0266T**850.44*807.92*929.11
**0267T**150.52*142.99*164.44
**0268T**316.08*300.28*345.32
**0269T**804.84*764.60*879.29
**0270T**150.52*142.99*164.44
**0271T**316.08*300.28*345.32
**0272T**52.02*49.42*56.83
**0273T**67.05*63.70*73.26
**0274T**1049.14*996.68*1146.18
**0278T**13.65*12.97*14.92
**0308T**1313.45*1247.78*1434.95
**0329T**78.86*74.92*86.16
#**0329T**30.29*28.78*33.10
**0330T**38.21*36.30*41.75
**0331T**168.85*160.41*184.47
**0332T**288.31*273.89*314.97
**0347T**134.64*127.91*147.10
**0348T**30.53*29.00*33.35
**0349T**32.30*30.69*35.29
**0350T**32.91*31.26*35.95
**0351T**156.41*148.59*170.88
**0352T**40.76*38.72*44.53
**0353T**156.41*148.59*170.88
**0354T**40.76*38.72*44.53
**0358T**24.59*23.36*26.86
**0362T**85.97*81.67*93.92
#**0362T**62.59*59.46*68.38
**0378T**23.61*22.43*25.79
**0394T**230.16*218.65*251.45
**0395T**560.60*532.57*612.46
**0397T**44.67*42.44*48.81
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**483.14*458.98*527.83
**0409T**333.72*317.03*364.58
**0410T**346.64*329.31*378.71
**0411T**346.64*329.31*378.71
**0412T**217.51*206.63*237.62
**0413T**451.65*429.07*493.43
**0414T**347.95*330.55*380.13
**0415T**290.03*275.53*316.86
**0416T**320.52*304.49*350.16
**0417T**77.91*74.01*85.11
**0418T**52.02*49.42*56.83
**0419T**420.89*399.85*459.83
#**0419T**339.54*322.56*370.94
**0420T**599.72*569.73*655.19
#**0420T**499.25*474.29*545.43
**0421T**1492.31*1417.69*1630.34
#**0421T**657.88*624.99*718.74
**0437T**202.03*191.93*220.72
**0439T**66.75*63.41*72.92
**0440T**231.16*219.60*252.54
#**0440T**112.78*107.14*123.21
**0441T**231.16*219.60*252.54
#**0441T**112.78*107.14*123.21
**0442T**231.16*219.60*252.54
#**0442T**112.78*107.14*123.21
**0449T**714.67*678.94*780.78
**0464T**62.15*59.04*67.90
**0472T**62.56*59.43*68.34
**0473T**52.02*49.42*56.83
**0479T**59.81*56.82*65.34
**0480T**72.25*68.64*78.94
#**0480T**29.91*28.41*32.67
**0483T**1128.50*1072.08*1232.89
**0484T**1463.56*1390.38*1598.94
**0485T**22.04*20.94*24.08
**0485T*TC*8.04*7.64*8.79
**0485T*26*14.30*13.59*15.63
**0486T**44.09*41.89*48.17
**0486T*TC*15.78*14.99*17.24
**0486T*26*28.31*26.89*30.92
**0488T**59.45*56.48*64.95
#**0488T**47.61*45.23*52.01
**0505T**10285.27*9771.01*11236.66
#**0505T**552.62*524.99*603.74
**0507T**21.37*20.30*23.35
**0507T*TC*18.52*17.59*20.23
**0507T*26*2.85*2.71*3.12
**0510T**563.89*535.70*616.06
#**0510T**399.97*379.97*436.97
**0512T**293.86*279.17*321.05
#**0512T**213.42*202.75*233.16
**0513T**88.16*83.75*96.31
#**0513T**64.03*60.83*69.95
**0515T**483.14*458.98*527.83
**0516T**445.91*423.61*487.15
**0517T**316.08*300.28*345.32
**0518T**217.51*206.63*237.62
**0519T**316.92*301.07*346.23
**0520T**445.91*423.61*487.15
**0521T**52.02*49.42*56.83
**0521T*TC*32.78*31.14*35.81
**0521T*26*19.24*18.28*21.02
**0522T**62.56*59.43*68.34
**0522T*TC*33.39*31.72*36.48
**0522T*26*29.17*27.71*31.87
**0523T**141.84*134.75*154.96
**0524T**1503.85*1428.66*1642.96
#**0524T**167.98*159.58*183.52
**0525T**446.21*423.90*487.49
**0526T**346.64*329.31*378.71
**0527T**301.78*286.69*329.69
**0528T**62.56*59.43*68.34
**0528T*TC*33.39*31.72*36.48
**0528T*26*29.17*27.71*31.87
**0529T**52.02*49.42*56.83
**0529T*TC*32.78*31.14*35.81
**0529T*26*19.24*18.28*21.02
**0530T**593.26*563.60*648.14
**0531T**451.65*429.07*493.43
**0532T**316.92*301.07*346.23
**0540T**167.73*159.34*183.24
**0543T**1463.56*1390.38*1598.94
**0544T**1680.50*1596.48*1835.95
**0545T**1680.50*1596.48*1835.95
**0546T**67.05*63.70*73.26
**0552T**6.21*5.90*6.79
**0553T**2254.33*2141.61*2462.85
#**0553T**372.09*353.49*406.51
**0565T**575.43*546.66*628.66
#**0565T**484.67*460.44*529.51
**0566T**93.38*88.71*102.02
#**0566T**56.04*53.24*61.23
**0569T**1680.50*1596.48*1835.95
**0570T**394.62*374.89*431.12
**0571T**522.46*496.34*570.79
**0572T**425.47*404.20*464.83
**0573T**324.31*308.09*354.30
**0574T**376.35*357.53*411.16
**0575T**62.56*59.43*68.34
**0576T**52.02*49.42*56.83
**0577T**179.97*170.97*196.62
**0578T**27.84*26.45*30.42
**0579T**19.43*18.46*21.23
**0580T**200.57*190.54*219.12
**0581T**2073.13*1969.47*2264.89
#**0581T**199.08*189.13*217.50
**0582T**1522.41*1446.29*1663.23
#**0582T**362.59*344.46*396.13
**0583T**1496.16*1421.35*1634.55
#**0583T**124.78*118.54*136.32
**0587T**414.94*394.19*453.32
#**0587T**280.17*266.16*306.08
**0588T**341.09*324.04*372.65
#**0588T**218.16*207.25*238.34
**0589T**45.57*43.29*49.78
#**0589T**36.77*34.93*40.17
**0590T**53.51*50.83*58.45
#**0590T**38.03*36.13*41.55
**0596T**2235.23*2123.47*2441.99
#**0596T**125.73*119.44*137.36
**0597T**672.69*639.06*734.92
#**0597T**125.73*119.44*137.36
**0598T**138.43*131.51*151.24
**0599T**92.27*87.66*100.81
**0600T**3291.13*3126.57*3595.56
#**0600T**688.59*654.16*752.28
**0601T**1375.07*1306.32*1502.27
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**182.01*172.91*198.85
**0611T**37.03*35.18*40.46
**0614T**347.39*330.02*379.52
**0615T**44.40*42.18*48.51
**0616T**623.00*591.85*680.63
**0617T**695.57*660.79*759.91
**0618T**841.82*799.73*919.69
**0619T**612.08*581.48*668.70
#**0619T**450.20*427.69*491.84
**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**239.84*227.85*262.03
#**0627T**94.14*89.43*102.84
**0628T**71.95*68.35*78.60
#**0628T**28.24*26.83*30.85
**0629T**239.84*227.85*262.03
#**0629T**94.14*89.43*102.84
**0630T**71.95*68.35*78.60
#**0630T**28.24*26.83*30.85
**0631T**75.57*71.79*82.56
**0632T**540.34*513.32*590.32
**0633T**186.32*177.00*203.55
*C*0633T*TC*97.13*92.27*106.11
**0633T*26*56.10*53.30*61.30
**0634T**186.32*177.00*203.55
**0634T*TC*130.22*123.71*142.27
**0634T*26*56.10*53.30*61.30
**0635T**186.32*177.00*203.55
**0635T*TC*130.22*123.71*142.27
**0635T*26*56.10*53.30*61.30
**0636T**186.32*177.00*203.55
**0636T*TC*130.22*123.71*142.27
**0636T*26*56.10*53.30*61.30
**0637T**186.32*177.00*203.55
**0637T*TC*130.22*123.71*142.27
**0637T*26*56.10*53.30*61.30
**0638T**186.32*177.00*203.55
**0638T*TC*130.22*123.71*142.27
**0638T*26*56.10*53.30*61.30
**0639T**75.57*71.79*82.56
**0640T**21.37*20.30*23.35
**0640T*TC*18.52*17.59*20.23
**0640T*26*2.85*2.71*3.12
**0644T**1068.92*1015.47*1167.79
#**0644T**227.21*215.85*248.23
**0646T**1680.50*1596.48*1835.95
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**55.57*52.79*60.71
**0652T**266.93*253.58*291.62
#**0652T**115.16*109.40*125.81
**0653T**348.08*330.68*380.28
#**0653T**130.14*123.63*142.17
**0654T**133.72*127.03*146.08
**0655T**1492.31*1417.69*1630.34
#**0655T**657.88*624.99*718.74
**0658T**86.51*82.18*94.51
**0659T**2470.04*2346.54*2698.52
#**0659T**410.53*390.00*448.50
**0671T**960.92*912.87*1049.80
**0673T**3140.43*2983.41*3430.92
#**0673T**345.14*327.88*377.06
**0699T**105.73*100.44*115.51
#**0699T**85.69*81.41*93.62
**0707T**345.28*328.02*377.22
#**0707T**261.20*248.14*285.36
**0714T**1293.24*1228.58*1412.87
#**0714T**338.31*321.39*369.60
**0730T**255.11*242.35*278.70
#**0730T**229.44*217.97*250.67
**0738T**67.15*63.79*73.36
**0739T**1492.31*1417.69*1630.34
#**0739T**657.88*624.99*718.74
**0740T**18.21*17.30*19.90
**0741T**43.10*40.95*47.09
**0742T**86.49*82.17*94.50
**0742T*TC*68.30*64.89*74.62
**0742T*26*18.20*17.29*19.88
**0743T**49.28*46.82*53.84
**0744T**839.22*797.26*916.85
**0745T**234.33*222.61*256.00
**0746T**213.61*202.93*233.37
**0747T**906.05*860.75*989.86
**0748T**173.52*164.84*189.57
**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**402.20*382.09*439.40
**0756T**102.97*97.82*112.49
**0757T**74.64*70.91*81.55
**0758T**83.03*78.88*90.71
**0759T**123.89*117.70*135.36
**0760T**92.13*87.52*100.65
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**108.88*103.44*118.96
**0764T**4.04*3.84*4.42
**0765T**7.69*7.31*8.41
**0771T**25.08*23.83*27.40
**0772T**25.08*23.83*27.40
**0773T**21.68*20.60*23.69
**0774T**21.68*20.60*23.69
**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**399.48*379.51*436.44
**0779T*TC*374.87*356.13*409.55
**0779T*26*24.61*23.38*26.89
**0780T**21.68*20.60*23.69
**0783T**13.05*12.40*14.26
**0784T**1946.06*1848.76*2126.07
#**0784T**307.55*292.17*336.00
**0785T**226.00*214.70*246.91
#**0785T**136.46*129.64*149.09
**0786T**680.74*646.70*743.71
#**0786T**287.96*273.56*314.59
**0787T**226.00*214.70*246.91
#**0787T**136.46*129.64*149.09
**0788T**17.83*16.94*19.48
#**0788T**17.23*16.37*18.83
**0789T**24.79*23.55*27.08
#**0789T**21.53*20.45*23.52
**0790T**1825.69*1734.41*1994.57
**0791T**8.55*8.12*9.34
**0793T**540.34*513.32*590.32
**0794T**130.35*123.83*142.40
**0795T**668.87*635.43*730.74
**0796T**445.91*423.61*487.15
**0797T**445.91*423.61*487.15
**0798T**708.10*672.70*773.61
**0799T**472.07*448.47*515.74
**0800T**472.07*448.47*515.74
**0801T**917.98*872.08*1002.89
**0802T**458.99*436.04*501.45
**0803T**458.99*436.04*501.45
**0804T**73.17*69.51*79.94
**0804T*TC*38.55*36.62*42.11
**0804T*26*34.62*32.89*37.82
**0805T**2711.35*2575.78*2962.15
#**0805T**308.24*292.83*336.75
**0806T**3615.14*3434.38*3949.54
#**0806T**410.98*390.43*448.99
**0807T**39.57*37.59*43.23
**0807T*TC*25.50*24.23*27.86
**0807T*26*14.07*13.37*15.38
**0808T**39.57*37.59*43.23
**0808T*TC*25.50*24.23*27.86
**0808T*26*14.07*13.37*15.38
**0810T**1065.21*1011.95*1163.74
**0811T**18.21*17.30*19.90
**0813T**2374.99*2256.24*2594.68
#**0813T**170.69*162.16*186.48
**0814T**431.60*410.02*471.52
#**0814T**326.50*310.18*356.71
**0818T**341.09*324.04*372.65
#**0818T**218.16*207.25*238.34
**0820T**141.39*134.32*154.47
#**0820T**125.30*119.04*136.90
**0821T**141.39*134.32*154.47
#**0821T**125.30*119.04*136.90
**0822T**120.18*114.17*131.30
#**0822T**106.51*101.18*116.36
**0823T**668.87*635.43*730.74
**0824T**708.10*672.70*773.61
**0825T**917.98*872.08*1002.89
**0826T**62.56*59.43*68.34
**0826T*TC*33.39*31.72*36.48
**0826T*26*29.17*27.71*31.87
**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**21.37*20.30*23.35
**0859T*TC*18.52*17.59*20.23
**0859T*26*2.85*2.71*3.12
**0864T**293.86*279.17*321.05
#**0864T**213.42*202.75*233.16
**10011**393.61*373.93*430.02
#**10011**102.52*97.39*112.00
**10012**217.93*207.03*238.08
#**10012**68.58*65.15*74.92
**15847**332.65*316.02*363.42
**21088**1692.77*1608.13*1849.35
**21742**1096.14*1041.33*1197.53
**21743**1259.22*1196.26*1375.70
**24940**1553.73*1476.04*1697.45
**32855**414.85*394.11*453.23
**32856**428.87*407.43*468.54
**33928**3147.14*2989.78*3438.25
**33929**1178.86*1119.92*1287.91
**33933**543.13*515.97*593.37
**33944**470.15*446.64*513.64
**34841**2078.82*1974.88*2271.11
**34842**2304.60*2189.37*2517.78
**34843**2530.41*2403.89*2764.47
**34844**2756.17*2618.36*3011.11
**34845**2078.82*1974.88*2271.11
**34846**2304.60*2189.37*2517.78
**34847**2530.41*2403.89*2764.47
**34848**2756.17*2618.36*3011.11
**43496**2069.92*1966.42*2261.38
**43647**726.42*690.10*793.62
**43648**519.07*493.12*567.09
#**43648**236.00*224.20*257.83
**43881**666.77*633.43*728.44
#**43881**614.81*584.07*671.68
**43882**701.98*666.88*766.91
#**43882**646.04*613.74*705.80
**44137**1627.14*1545.78*1777.65
**44715**414.85*394.11*453.23
**47143**413.82*393.13*452.10
**47144**491.41*466.84*536.87
**47145**465.55*442.27*508.61
**48551**414.85*394.11*453.23
**49906**1974.88*1876.14*2157.56
**50323**557.53*529.65*609.10
**50325**278.02*264.12*303.74
**53451**718.79*682.85*785.28
**53452**359.39*341.42*392.63
**53453**610.87*580.33*667.38
**53454**53.27*50.61*58.20
#**53454**33.54*31.86*36.64
**54440**742.45*705.33*811.13
**63043**543.65*516.47*593.94
**63044**516.85*491.01*564.66
**64596**1946.06*1848.76*2126.07
#**64596**307.55*292.17*336.00
**64597**583.82*554.63*637.82
#**64597**92.27*87.66*100.81
**64598**226.00*214.70*246.91
#**64598**136.46*129.64*149.09
**65757**112.69*107.06*123.12
**66983**623.00*591.85*680.63
**66987**724.73*688.49*791.76
**66988**600.66*570.63*656.22
*C*70170**230.19*218.68*251.48
*C*70170*TC*216.42*205.60*236.44
**70555**233.47*221.80*255.07
**70555*TC*121.17*115.11*132.38
*C*70557**630.69*599.16*689.03
*C*70557*TC*487.18*462.82*532.24
*C*70558**320.59*304.56*350.24
*C*70558*TC*162.39*154.27*177.41
*C*70559**311.47*295.90*340.29
*C*70559*TC*162.39*154.27*177.41
*C*74190**508.05*482.65*555.05
*C*74190*TC*487.18*462.82*532.24
**74235**136.39*129.57*149.01
**74235*TC*82.86*78.72*90.53
**74300**78.17*74.26*85.40
**74300*TC*65.69*62.41*71.77
**74301**24.09*22.89*26.32
**74301*TC*14.79*14.05*16.16
**74328**175.06*166.31*191.26
**74328*TC*153.30*145.64*167.49
**74329**131.57*124.99*143.74
**74329*TC*109.50*104.03*119.63
**74330**262.59*249.46*286.88
**74330*TC*236.97*225.12*258.89
**74340**86.58*82.25*94.59
**74340*TC*62.53*59.40*68.31
**74355**86.58*82.25*94.59
**74355*TC*52.29*49.68*57.13
**74360**86.58*82.25*94.59
**74360*TC*61.01*57.96*66.65
**74363**175.06*166.31*191.26
**74363*TC*135.93*129.13*148.50
*C*74445**147.81*140.42*161.48
*C*74445*TC*97.13*92.27*106.11
*C*74450**231.17*219.61*252.55
*C*74450*TC*216.42*205.60*236.44
*C*74470**510.63*485.10*557.87
*C*74470*TC*487.18*462.82*532.24
**74742**233.47*221.80*255.07
**74742*TC*205.91*195.61*224.95
*C*74775**244.31*232.09*266.90
*C*74775*TC*216.42*205.60*236.44
*C*75801**595.04*565.29*650.08
**75801*TC*544.87*517.63*595.27
*C*75803**1467.37*1394.00*1603.10
*C*75803*TC*1414.49*1343.77*1545.34
*C*75805**2851.86*2709.27*3115.66
*C*75805*TC*2815.32*2674.55*3075.73
*C*75807**2865.16*2721.90*3130.19
*C*75807*TC*2815.32*2674.55*3075.73
*C*75810**2861.14*2718.08*3125.79
*C*75810*TC*2815.32*2674.55*3075.73
**75894**831.40*789.83*908.30
**75894*TC*764.24*726.03*834.93
*C*75898**2900.89*2755.85*3169.23
*C*75898*TC*2815.32*2674.55*3075.73
**75970**406.26*385.95*443.84
**75970*TC*370.59*352.06*404.87
**76125**37.07*35.22*40.50
**76125*TC*24.59*23.36*26.86
**76390**190.82*181.28*208.47
**76390*TC*141.15*134.09*154.20
**76390*26*49.67*47.19*54.27
**76932**79.30*75.34*86.64
**76932*TC*45.53*43.25*49.74
**76940**149.53*142.05*163.36
**76940*TC*54.92*52.17*60.00
**76941**109.13*103.67*119.22
**76941*TC*48.56*46.13*53.05
**76945**78.39*74.47*85.64
**76945*TC*48.26*45.85*52.73
*C*76975**254.78*242.04*278.35
*C*76975*TC*216.42*205.60*236.44
**76998**175.06*166.31*191.26
**76998*TC*131.01*124.46*143.13
**77013**390.90*371.36*427.06
**77013*TC*218.38*207.46*238.58
**77022**440.01*418.01*480.71
**77022*TC*252.02*239.42*275.33
**77371**1158.85*1100.91*1266.05
**77520**816.55*775.72*892.08
**77522**816.55*775.72*892.08
**77523**937.53*890.65*1024.25
**77525**1058.51*1005.58*1156.42
*C*78282**378.81*359.87*413.85
*C*78282*TC*364.25*346.04*397.95
**78414**514.99*489.24*562.63
**78414*TC*495.10*470.35*540.90
*C*78429**1456.33*1383.51*1591.04
*C*78429*TC*1381.71*1312.62*1509.51
*C*78430**1452.78*1380.14*1587.16
*C*78430*TC*1381.71*1312.62*1509.51
*C*78431**2169.07*2060.62*2369.71
*C*78431*TC*2086.22*1981.91*2279.20
*C*78432**1804.02*1713.82*1970.89
*C*78432*TC*1715.30*1629.54*1873.97
*C*78433**1905.25*1809.99*2081.49
*C*78433*TC*1808.18*1717.77*1975.44
**78434**650.72*618.18*710.91
**78434*TC*623.41*592.24*681.08
*C*78459**1323.33*1257.16*1445.73
*C*78459*TC*1254.22*1191.51*1370.24
*C*78491**1449.48*1377.01*1583.56
*C*78491*TC*1381.71*1312.62*1509.51
*C*78492**1461.28*1388.22*1596.45
*C*78492*TC*1381.71*1312.62*1509.51
*C*78608**1446.91*1374.56*1580.74
*C*78608*TC*1381.71*1312.62*1509.51
*C*78811**1321.34*1255.27*1443.56
*C*78811*TC*1254.22*1191.51*1370.24
*C*78812**1466.45*1393.13*1602.10
*C*78812*TC*1381.71*1312.62*1509.51
*C*78813**1468.44*1395.02*1604.27
*C*78813*TC*1381.71*1312.62*1509.51
*C*78814**1477.72*1403.83*1614.40
*C*78814*TC*1381.71*1312.62*1509.51
*C*78815**1488.61*1414.18*1626.31
*C*78815*TC*1381.71*1312.62*1509.51
*C*78816**1489.67*1415.19*1627.47
*C*78816*TC*1381.71*1312.62*1509.51
**79300**237.04*225.19*258.97
**79300*TC*176.46*167.64*192.79
**79445**237.04*225.19*258.97
**79445*TC*133.88*127.19*146.27
**86485**5.36*5.09*5.85
**90867**277.90*264.01*303.61
#**90867**129.02*122.57*140.96
**90868**188.06*178.66*205.46
#**90868**100.29*95.28*109.57
**90869**259.64*246.66*283.66
#**90869**151.03*143.48*165.00
**90952**478.81*454.87*523.10
**90953**340.54*323.51*372.04
**92978**228.29*216.88*249.41
**92978*TC*140.23*133.22*153.20
**92979**139.41*132.44*152.31
**92979*TC*69.51*66.03*75.93
*C*93315**605.61*575.33*661.63
*C*93315*TC*487.18*462.82*532.24
**93317**199.83*189.84*218.32
**93317*TC*117.43*111.56*128.29
*C*93318**582.46*553.34*636.34
*C*93318*TC*487.18*462.82*532.24
**93571**227.38*216.01*248.41
**93571*TC*160.35*152.33*175.18
**93572**137.29*130.43*149.99
**93572*TC*88.47*84.05*96.66
**93600**3557.81*3379.92*3886.91
**93600*TC*3450.17*3277.66*3769.31
**93602**3557.81*3379.92*3886.91
**93602*TC*3451.99*3279.39*3771.30
**93603**3557.81*3379.92*3886.91
**93603*TC*3451.99*3279.39*3771.30
**93609**2134.69*2027.96*2332.15
**93609*TC*1882.12*1788.01*2056.21
**93610**3557.81*3379.92*3886.91
**93610*TC*3408.27*3237.86*3723.54
**93612**3557.81*3379.92*3886.91
**93612*TC*3410.39*3239.87*3725.85
**93615**46.17*43.86*50.44
**93615*TC*12.53*11.90*13.69
**93616**77.69*73.81*84.88
**93616*TC*23.13*21.97*25.27
**93619**7115.62*6759.84*7773.82
**93619*TC*6758.87*6420.93*7384.07
**93620**7115.62*6759.84*7773.82
**93620*TC*6543.24*6216.08*7148.49
**93621**7115.62*6759.84*7773.82
**93621*TC*7039.51*6687.53*7690.66
**93622**7115.62*6759.84*7773.82
**93622*TC*6958.60*6610.67*7602.27
**93623**2134.69*2027.96*2332.15
**93623*TC*2063.04*1959.89*2253.87
**93624**3557.81*3379.92*3886.91
**93624*TC*3335.43*3168.66*3643.96
**93631**7115.62*6759.84*7773.82
**93631*TC*6748.81*6411.37*7373.08
**93640**1133.95*1077.25*1238.84
**93640*TC*970.48*921.96*1060.25
**93641**1133.95*1077.25*1238.84
**93641*TC*848.19*805.78*926.65
**93662**394.29*374.58*430.77
**93662*TC*328.63*312.20*359.03
**93745**88.06*83.66*96.21
**93745*TC*66.03*62.73*72.14
**93745*26*22.00*20.90*24.04
**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**60.96*57.91*66.60
**95824*TC*24.59*23.36*26.86
**95965**914.83*869.09*999.45
**95965*TC*529.38*502.91*578.35
**96020**344.38*327.16*376.23
**96020*TC*195.96*186.16*214.08
**96547**684.38*650.16*747.68
#**96547**126.78*120.44*138.51
**96548**342.19*325.08*373.84
#**96548**63.39*60.22*69.25
**97039**13.15*12.49*14.36
**97139**17.78*16.89*19.42
**97151**47.70*45.32*52.12
#**97151**42.54*40.41*46.47
**97152**40.55*38.52*44.30
#**97152**36.16*34.35*39.50
**97153**32.32*30.70*35.31
#**97153**28.53*27.10*31.17
**97154**4.40*4.18*4.81
#**97154**4.01*3.81*4.38
**97155**32.32*30.70*35.31
#**97155**28.53*27.10*31.17
**97156**34.11*32.40*37.26
#**97156**30.16*28.65*32.95
**97157**9.93*9.43*10.84
#**97157**9.02*8.57*9.86
**97158**5.12*4.86*5.59
#**97158**4.66*4.43*5.09
**98978**43.10*40.95*47.09
# - 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.