NEW JERSEY MEDICARE CARRIER - 12402
MEDICARE FEE SCHEDULE EFFECTIVE 01/01/2024
NORTHERN NJ
******
**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**509.93*484.43*557.09
#**G0186**435.48*413.71*475.77
**G0339**3357.39*3189.52*3667.95
**G0340**2525.00*2398.75*2758.56
**G0398**153.34*145.67*167.52
**G0398*TC*111.97*106.37*122.33
**G0398*26*41.37*39.30*45.20
**G0399**105.09*99.84*114.82
**G0399*TC*59.39*56.42*64.88
**G0399*26*46.08*43.78*50.35
**G0400**108.82*103.38*118.89
**G0400*TC*65.92*62.62*72.01
**G0400*26*42.91*40.76*46.87
**G0460**908.31*862.89*992.32
#**G0460**128.89*122.45*140.82
**G0465**908.31*862.89*992.32
#**G0465**128.89*122.45*140.82
**G0498**168.56*160.13*184.15
**G6017**86.69*82.36*94.71
**0042T**255.00*242.25*278.59
**0054T**246.50*234.18*269.31
**0055T**246.50*234.18*269.31
**0071T**622.36*591.24*679.93
**0072T**622.36*591.24*679.93
**0075T**1026.03*974.73*1120.94
**0075T*TC*1026.03*974.73*1120.94
**0075T*26*1030.68*979.15*1126.02
**0076T**1149.73*1092.24*1256.08
**0076T*TC*919.77*873.78*1004.85
**0076T*26*229.94*218.44*251.21
**0095T**677.04*643.19*739.67
**0098T**757.03*719.18*827.06
**0100T**2074.24*1970.53*2266.11
**0101T**347.54*330.16*379.68
#**0101T**245.85*233.56*268.59
**0102T**347.54*330.16*379.68
#**0102T**245.85*233.56*268.59
**0106T**38.49*36.57*42.06
**0107T**38.49*36.57*42.06
**0108T**38.49*36.57*42.06
**0109T**38.49*36.57*42.06
**0110T**38.49*36.57*42.06
**0164T**740.80*703.76*809.32
**0165T**758.80*720.86*828.99
**0174T**10.51*9.98*11.48
**0184T**897.06*852.21*980.04
**0198T**95.61*90.83*104.45
#**0198T**34.21*32.50*37.38
**0200T**2016.16*1915.35*2202.65
#**0200T**432.76*411.12*472.79
**0201T**3024.24*2873.03*3303.98
#**0201T**649.14*616.68*709.18
**0207T**121.70*115.62*132.96
**0208T**43.70*41.52*47.75
**0209T**52.91*50.26*57.80
**0210T**33.34*31.67*36.42
**0211T**51.76*49.17*56.55
**0212T**39.62*37.64*43.29
#**0212T**33.86*32.17*37.00
**0213T**214.94*204.19*234.82
#**0213T**113.24*107.58*123.72
**0214T**107.41*102.04*117.35
#**0214T**62.89*59.75*68.71
**0215T**107.79*102.40*117.76
#**0215T**64.04*60.84*69.97
**0216T**198.48*188.56*216.84
#**0216T**97.55*92.67*106.57
**0217T**100.77*95.73*110.09
#**0217T**53.95*51.25*58.94
**0218T**100.77*95.73*110.09
#**0218T**55.10*52.35*60.20
**0219T**1433.95*1362.25*1566.59
**0220T**1409.16*1338.70*1539.51
**0221T**1719.89*1633.90*1878.99
**0222T**416.73*395.89*455.27
**0232T**908.31*862.89*992.32
#**0232T**128.89*122.45*140.82
**0234T**9798.36*9308.44*10704.71
#**0234T**614.93*584.18*671.81
**0235T**9798.36*9308.44*10704.71
#**0235T**614.93*584.18*671.81
**0236T**9962.27*9464.16*10883.78
#**0236T**711.69*676.11*777.53
**0237T**9962.27*9464.16*10883.78
#**0237T**711.69*676.11*777.53
**0238T**9962.27*9464.16*10883.78
#**0238T**711.69*676.11*777.53
**0253T**1039.17*987.21*1135.29
**0266T**962.05*913.95*1051.04
**0267T**167.46*159.09*182.95
**0268T**359.54*341.56*392.79
**0269T**913.21*867.55*997.68
**0270T**167.46*159.09*182.95
**0271T**359.54*341.56*392.79
**0272T**62.86*59.72*68.68
**0273T**79.67*75.69*87.04
**0274T**1206.62*1146.29*1318.23
**0278T**15.57*14.79*17.01
**0308T**1524.14*1447.93*1665.12
**0329T**95.61*90.83*104.45
#**0329T**34.21*32.50*37.38
**0330T**38.21*36.30*41.75
**0331T**207.92*197.52*227.15
**0332T**355.01*337.26*387.85
**0347T**151.63*144.05*165.66
**0348T**37.19*35.33*40.63
**0349T**39.57*37.59*43.23
**0350T**40.33*38.31*44.06
**0351T**192.32*182.70*210.11
**0352T**46.15*43.84*50.42
**0353T**192.32*182.70*210.11
**0354T**46.15*43.84*50.42
**0358T**31.04*29.49*33.91
**0362T**99.71*94.72*108.93
#**0362T**70.16*66.65*76.65
**0378T**26.56*25.23*29.01
**0394T**283.70*269.52*309.95
**0395T**682.62*648.49*745.76
**0397T**50.28*47.77*54.94
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**546.26*518.95*596.79
**0409T**379.90*360.91*415.05
**0410T**395.67*375.89*432.27
**0411T**395.67*375.89*432.27
**0412T**251.16*238.60*274.39
**0413T**512.99*487.34*560.44
**0414T**396.00*376.20*432.63
**0415T**329.33*312.86*359.79
**0416T**368.38*349.96*402.45
**0417T**92.75*88.11*101.33
**0418T**62.86*59.72*68.68
**0419T**498.33*473.41*544.42
#**0419T**395.48*375.71*432.07
**0420T**704.46*669.24*769.63
#**0420T**577.44*548.57*630.86
**0421T**1800.32*1710.30*1966.85
#**0421T**745.36*708.09*814.30
**0437T**228.29*216.88*249.41
**0439T**80.50*76.48*87.95
**0440T**278.32*264.40*304.06
#**0440T**128.65*122.22*140.55
**0441T**278.32*264.40*304.06
#**0441T**128.65*122.22*140.55
**0442T**278.32*264.40*304.06
#**0442T**128.65*122.22*140.55
**0449T**836.06*794.26*913.40
**0464T**76.19*72.38*83.24
**0472T**74.70*70.97*81.62
**0473T**62.86*59.72*68.68
**0479T**67.85*64.46*74.13
**0480T**87.46*83.09*95.55
#**0480T**33.93*32.23*37.06
**0483T**1255.80*1193.01*1371.96
**0484T**1627.36*1545.99*1777.89
**0485T**26.05*24.75*28.46
**0485T*TC*10.12*9.61*11.05
**0485T*26*16.27*15.46*17.78
**0486T**52.11*49.50*56.93
**0486T*TC*19.91*18.91*21.75
**0486T*26*32.20*30.59*35.18
**0488T**68.29*64.88*74.61
#**0488T**53.32*50.65*58.25
**0505T**12855.61*12212.83*14044.75
#**0505T**585.81*556.52*640.00
**0507T**26.59*25.26*29.05
**0507T*TC*23.36*22.19*25.52
**0507T*26*3.23*3.07*3.53
**0510T**669.06*635.61*730.95
#**0510T**461.83*438.74*504.55
**0512T**347.54*330.16*379.68
#**0512T**245.85*233.56*268.59
**0513T**104.26*99.05*113.91
#**0513T**73.75*70.06*80.57
**0515T**546.26*518.95*596.79
**0516T**504.64*479.41*551.32
**0517T**359.54*341.56*392.79
**0518T**251.16*238.60*274.39
**0519T**360.80*342.76*394.17
**0520T**504.64*479.41*551.32
**0521T**62.86*59.72*68.68
**0521T*TC*41.40*39.33*45.23
**0521T*26*21.46*20.39*23.45
**0522T**74.70*70.97*81.62
**0522T*TC*42.17*40.06*46.07
**0522T*26*32.53*30.90*35.54
**0523T**168.71*160.27*184.31
**0524T**1875.12*1781.36*2048.56
#**0524T**186.18*176.87*203.40
**0525T**505.02*479.77*551.74
**0526T**395.67*375.89*432.27
**0527T**343.50*326.33*375.28
**0528T**74.70*70.97*81.62
**0528T*TC*42.17*40.06*46.07
**0528T*26*32.53*30.90*35.54
**0529T**62.86*59.72*68.68
**0529T*TC*41.40*39.33*45.23
**0529T*26*21.46*20.39*23.45
**0530T**674.95*641.20*737.38
**0531T**512.99*487.34*560.44
**0532T**360.80*342.76*394.17
**0540T**191.48*181.91*209.20
**0543T**1627.36*1545.99*1777.89
**0544T**1879.74*1785.75*2053.61
**0545T**1879.74*1785.75*2053.61
**0546T**79.76*75.77*87.14
**0552T**7.42*7.05*8.11
**0553T**2790.49*2650.97*3048.62
#**0553T**410.79*390.25*448.79
**0565T**677.74*643.85*740.43
#**0565T**563.00*534.85*615.08
**0566T**110.17*104.66*120.36
#**0566T**62.96*59.81*68.78
**0569T**1879.74*1785.75*2053.61
**0570T**438.76*416.82*479.34
**0571T**591.58*562.00*646.30
**0572T**480.98*456.93*525.47
**0573T**368.89*350.45*403.02
**0574T**426.38*405.06*465.82
**0575T**74.70*70.97*81.62
**0576T**62.86*59.72*68.68
**0577T**207.15*196.79*226.31
**0578T**31.08*29.53*33.96
**0579T**24.51*23.28*26.77
**0580T**230.50*218.98*251.83
**0581T**2592.56*2462.93*2832.37
#**0581T**223.21*212.05*243.86
**0582T**1882.60*1788.47*2056.74
#**0582T**416.24*395.43*454.74
**0583T**1496.16*1421.35*1634.55
#**0583T**146.62*139.29*160.18
**0587T**487.87*463.48*533.00
#**0587T**317.48*301.61*346.85
**0588T**403.87*383.68*441.23
#**0588T**248.44*236.02*271.42
**0589T**52.18*49.57*57.01
#**0589T**41.05*39.00*44.85
**0590T**62.04*58.94*67.78
#**0590T**42.47*40.35*46.40
**0596T**2235.23*2123.47*2441.99
#**0596T**137.95*131.05*150.71
**0597T**672.69*639.06*734.92
#**0597T**137.95*131.05*150.71
**0598T**173.22*164.56*189.24
**0599T**114.97*109.22*125.60
**0600T**4055.67*3852.89*4430.82
#**0600T**765.29*727.03*836.08
**0601T**1550.68*1473.15*1694.12
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**219.96*208.96*240.30
**0611T**46.73*44.39*51.05
**0614T**395.16*375.40*431.71
**0615T**51.60*49.02*56.37
**0616T**722.04*685.94*788.83
**0617T**808.63*768.20*883.43
**0618T**979.57*930.59*1070.18
**0619T**720.00*684.00*786.60
#**0619T**515.60*489.82*563.29
**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**290.61*276.08*317.49
#**0627T**106.40*101.08*116.24
**0628T**87.18*82.82*95.24
#**0628T**31.92*30.32*34.87
**0629T**290.61*276.08*317.49
#**0629T**106.40*101.08*116.24
**0630T**87.18*82.82*95.24
#**0630T**31.92*30.32*34.87
**0631T**93.68*89.00*102.35
**0632T**605.55*575.27*661.56
**0633T**227.01*215.66*248.01
*C*0633T*TC*122.76*116.62*134.11
**0633T*26*62.46*59.34*68.24
**0634T**227.01*215.66*248.01
**0634T*TC*164.54*156.31*179.76
**0634T*26*62.46*59.34*68.24
**0635T**227.01*215.66*248.01
**0635T*TC*164.54*156.31*179.76
**0635T*26*62.46*59.34*68.24
**0636T**227.01*215.66*248.01
**0636T*TC*164.54*156.31*179.76
**0636T*26*62.46*59.34*68.24
**0637T**227.01*215.66*248.01
**0637T*TC*164.54*156.31*179.76
**0637T*26*62.46*59.34*68.24
**0638T**227.01*215.66*248.01
**0638T*TC*164.54*156.31*179.76
**0638T*26*62.46*59.34*68.24
**0639T**93.68*89.00*102.35
**0640T**26.59*25.26*29.05
**0640T*TC*23.36*22.19*25.52
**0640T*26*3.23*3.07*3.53
**0644T**1314.61*1248.88*1436.21
#**0644T**250.44*237.92*273.61
**0646T**1879.74*1785.75*2053.61
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**66.72*63.38*72.89
**0652T**322.60*306.47*352.44
#**0652T**130.72*124.18*142.81
**0653T**423.06*401.91*462.20
#**0653T**147.52*140.14*161.16
**0654T**151.25*143.69*165.24
**0655T**1800.32*1710.30*1966.85
#**0655T**745.36*708.09*814.30
**0658T**109.33*103.86*119.44
**0659T**3056.88*2904.04*3339.65
#**0659T**453.05*430.40*494.96
**0671T**1123.59*1067.41*1227.52
**0673T**3919.52*3723.54*4282.07
#**0673T**385.45*366.18*421.11
**0699T**123.73*117.54*135.17
#**0699T**98.40*93.48*107.50
**0707T**416.09*395.29*454.58
#**0707T**309.79*294.30*338.45
**0714T**1596.52*1516.69*1744.19
#**0714T**389.20*369.74*425.20
**0730T**298.21*283.30*325.80
#**0730T**265.43*252.16*289.98
**0738T**76.01*72.21*83.04
**0739T**1800.32*1710.30*1966.85
#**0739T**745.36*708.09*814.30
**0740T**22.93*21.78*25.05
**0741T**54.45*51.73*59.49
**0742T**106.50*101.18*116.36
**0742T*TC*86.28*81.97*94.27
**0742T*26*20.23*19.22*22.10
**0743T**60.20*57.19*65.77
**0744T**931.65*885.07*1017.83
**0745T**295.94*281.14*323.31
**0746T**241.12*229.06*263.42
**0747T**1144.38*1087.16*1250.23
**0748T**198.26*188.35*216.60
**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**489.77*465.28*535.07
**0756T**126.56*120.23*138.26
**0757T**92.70*88.07*101.28
**0758T**101.93*96.83*111.35
**0759T**153.03*145.38*167.19
**0760T**111.79*106.20*122.13
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**131.99*125.39*144.20
**0764T**4.74*4.50*5.18
**0765T**8.56*8.13*9.35
**0771T**27.96*26.56*30.54
**0772T**27.96*26.56*30.54
**0773T**26.18*24.87*28.60
**0774T**26.18*24.87*28.60
**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**501.52*476.44*547.91
**0779T*TC*473.90*450.21*517.74
**0779T*26*27.62*26.24*30.18
**0780T**26.18*24.87*28.60
**0783T**16.46*15.64*17.99
**0784T**2419.82*2298.83*2643.65
#**0784T**348.27*330.86*380.49
**0785T**270.54*257.01*295.56
#**0785T**157.33*149.46*171.88
**0786T**821.65*780.57*897.66
#**0786T**325.06*308.81*355.13
**0787T**270.54*257.01*295.56
#**0787T**157.33*149.46*171.88
**0788T**20.12*19.11*21.98
#**0788T**19.35*18.38*21.14
**0789T**27.93*26.53*30.51
#**0789T**24.18*22.97*26.42
**0790T**2055.45*1952.68*2245.58
**0791T**9.88*9.39*10.80
**0793T**605.55*575.27*661.56
**0794T**130.35*123.83*142.40
**0795T**756.96*719.11*826.98
**0796T**504.64*479.41*551.32
**0797T**504.64*479.41*551.32
**0798T**797.31*757.44*871.06
**0799T**531.54*504.96*580.70
**0800T**531.54*504.96*580.70
**0801T**1036.18*984.37*1132.03
**0802T**518.09*492.19*566.02
**0803T**518.09*492.19*566.02
**0804T**87.32*82.95*95.39
**0804T*TC*48.69*46.26*53.20
**0804T*26*38.63*36.70*42.21
**0805T**3379.82*3210.83*3692.45
#**0805T**341.57*324.49*373.16
**0806T**4506.42*4281.10*4923.27
#**0806T**455.43*432.66*497.56
**0807T**47.88*45.49*52.31
**0807T*TC*32.19*30.58*35.17
**0807T*26*15.69*14.91*17.15
**0808T**47.88*45.49*52.31
**0808T*TC*32.19*30.58*35.17
**0808T*26*15.69*14.91*17.15
**0810T**1233.88*1172.19*1348.02
**0811T**22.93*21.78*25.05
**0813T**2979.18*2830.22*3254.75
#**0813T**192.30*182.69*210.09
**0814T**520.12*494.11*568.23
#**0814T**387.24*367.88*423.06
**0818T**403.87*383.68*441.23
#**0818T**248.44*236.02*271.42
**0820T**156.80*148.96*171.30
#**0820T**136.46*129.64*149.09
**0821T**156.80*148.96*171.30
#**0821T**136.46*129.64*149.09
**0822T**133.28*126.62*145.61
#**0822T**115.99*110.19*126.72
**0823T**756.96*719.11*826.98
**0824T**797.31*757.44*871.06
**0825T**1036.18*984.37*1132.03
**0826T**74.70*70.97*81.62
**0826T*TC*42.17*40.06*46.07
**0826T*26*32.53*30.90*35.54
**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**26.59*25.26*29.05
**0859T*TC*23.36*22.19*25.52
**0859T*26*3.23*3.07*3.53
**0864T**347.54*330.16*379.68
#**0864T**245.85*233.56*268.59
**10011**481.83*457.74*526.40
#**10011**113.80*108.11*124.33
**10012**263.75*250.56*288.14
#**10012**74.94*71.19*81.87
**15847**382.34*363.22*417.70
**21088**1970.56*1872.03*2152.83
**21742**1233.76*1172.07*1347.88
**21743**1415.24*1344.48*1546.15
**32855**482.92*458.77*527.59
**32856**477.47*453.60*521.64
**33928**3481.53*3307.45*3803.57
**33929**1304.12*1238.91*1424.75
**33933**586.30*556.99*640.54
**33944**547.29*519.93*597.92
**34841**2281.93*2167.83*2493.00
**34842**2507.71*2382.32*2739.67
**34843**2733.48*2596.81*2986.33
**34844**2959.27*2811.31*3233.01
**34845**2281.93*2167.83*2493.00
**34846**2507.71*2382.32*2739.67
**34847**2733.48*2596.81*2986.33
**34848**2959.27*2811.31*3233.01
**43496**2352.97*2235.32*2570.62
**43647**845.63*803.35*923.85
**43648**597.65*567.77*652.94
#**43648**265.27*252.01*289.81
**43881**770.18*731.67*841.42
#**43881**702.69*667.56*767.69
**43882**823.22*782.06*899.37
#**43882**750.59*713.06*820.02
**44137**1894.14*1799.43*2069.34
**44715**482.91*458.76*527.57
**47143**458.86*435.92*501.31
**47144**544.89*517.65*595.30
**47145**516.23*490.42*563.98
**48551**361.89*343.80*395.37
**49906**2291.08*2176.53*2503.01
**50323**435.07*413.32*475.32
**50325**298.03*283.13*325.60
**53451**816.34*775.52*891.85
**53452**408.17*387.76*445.92
**53453**693.97*659.27*758.16
**53454**62.49*59.37*68.28
#**53454**37.54*35.66*41.01
**54440**808.26*767.85*883.03
**63043**623.49*592.32*681.17
**63044**575.14*546.38*628.34
**64596**2419.82*2298.83*2643.65
#**64596**348.27*330.86*380.49
**64597**725.95*689.65*793.10
#**64597**104.48*99.26*114.15
**64598**270.54*257.01*295.56
#**64598**157.33*149.46*171.88
**65757**130.40*123.88*142.46
**66983**722.04*685.94*788.83
**66987**825.67*784.39*902.05
**66988**689.90*655.41*753.72
*C*70170**288.93*274.48*315.65
*C*70170*TC*273.58*259.90*298.89
**70555**233.47*221.80*255.07
**70555*TC*108.69*103.26*118.75
*C*70557**777.73*738.84*849.67
*C*70557*TC*615.89*585.10*672.87
*C*70558**383.65*364.47*419.14
*C*70558*TC*205.27*195.01*224.26
*C*70559**371.59*353.01*405.96
*C*70559*TC*205.27*195.01*224.26
*C*74190**639.00*607.05*698.11
*C*74190*TC*615.89*585.10*672.87
**74235**163.42*155.25*178.54
**74235*TC*103.82*98.63*113.42
**74300**96.51*91.68*105.43
**74300*TC*82.59*78.46*90.23
**74301**29.66*28.18*32.41
**74301*TC*19.32*18.35*21.10
**74328**175.06*166.31*191.26
**74328*TC*150.72*143.18*164.66
**74329**160.67*152.64*175.54
**74329*TC*135.94*129.14*148.51
**74330**262.59*249.46*286.88
**74330*TC*234.01*222.31*255.66
**74340**86.58*82.25*94.59
**74340*TC*59.85*56.86*65.39
**74355**86.58*82.25*94.59
**74355*TC*48.39*45.97*52.87
**74360**86.58*82.25*94.59
**74360*TC*58.02*55.12*63.39
**74363**175.06*166.31*191.26
**74363*TC*131.58*125.00*143.75
*C*74445**179.18*170.22*195.75
*C*74445*TC*122.76*116.62*134.11
*C*74450**290.02*275.52*316.85
*C*74450*TC*273.58*259.90*298.89
*C*74470**641.86*609.77*701.24
*C*74470*TC*615.89*585.10*672.87
**74742**233.47*221.80*255.07
**74742*TC*202.76*192.62*221.51
*C*74775**304.63*289.40*332.81
*C*74775*TC*273.58*259.90*298.89
*C*75801**746.36*709.04*815.40
*C*75801*TC*701.47*666.40*766.36
*C*75803**1847.19*1754.83*2018.05
*C*75803*TC*1788.29*1698.88*1953.71
*C*75805**3600.05*3420.05*3933.06
*C*75805*TC*3559.35*3381.38*3888.59
*C*75807**3614.33*3433.61*3948.65
*C*75807*TC*3559.35*3381.38*3888.59
*C*75810**3609.35*3428.88*3943.21
*C*75810*TC*3559.35*3381.38*3888.59
**75894**1036.12*984.31*1131.96
**75894*TC*961.02*912.97*1049.92
*C*75898**3655.09*3472.34*3993.19
*C*75898*TC*3559.35*3381.38*3888.59
**75970**505.08*479.83*551.80
**75970*TC*465.69*442.41*508.77
**76125**44.75*42.51*48.89
**76125*TC*30.83*29.29*33.68
**76390**233.39*221.72*254.98
**76390*TC*178.36*169.44*194.86
**76390*26*55.03*52.28*60.12
**76932**95.15*90.39*103.95
**76932*TC*57.25*54.39*62.55
**76940**172.71*164.07*188.68
**76940*TC*67.43*64.06*73.67
**76941**128.16*121.75*140.01
**76941*TC*60.51*57.48*66.10
**76945**94.04*89.34*102.74
**76945*TC*60.38*57.36*65.96
*C*76975**316.63*300.80*345.92
*C*76975*TC*273.58*259.90*298.89
**76998**175.06*166.31*191.26
**76998*TC*126.05*119.75*137.71
**77013**483.62*459.44*528.36
**77013*TC*292.80*278.16*319.88
**77022**535.48*508.71*585.02
**77022*TC*326.60*310.27*356.81
**77371**1551.95*1474.35*1695.50
**77520**1059.98*1006.98*1158.03
**77522**1059.98*1006.98*1158.03
**77523**1217.13*1156.27*1329.71
**77525**1374.26*1305.55*1501.38
*C*78282**476.35*452.53*520.41
*C*78282*TC*460.47*437.45*503.07
**78414**514.99*489.24*562.63
**78414*TC*492.83*468.19*538.42
*C*78429**1829.37*1737.90*1998.59
*C*78429*TC*1746.84*1659.50*1908.43
*C*78430**1825.52*1734.24*1994.38
*C*78430*TC*1746.84*1659.50*1908.43
*C*78431**2729.57*2593.09*2982.05
*C*78431*TC*2637.55*2505.67*2881.52
*C*78432**2266.87*2153.53*2476.56
*C*78432*TC*2168.59*2060.16*2369.18
*C*78433**2393.56*2273.88*2614.96
*C*78433*TC*2286.02*2171.72*2497.48
**78434**818.87*777.93*894.62
**78434*TC*788.57*749.14*861.51
*C*78459**1662.20*1579.09*1815.95
*C*78459*TC*1585.66*1506.38*1732.34
*C*78491**1822.07*1730.97*1990.62
*C*78491*TC*1746.84*1659.50*1908.43
*C*78492**1835.37*1743.60*2005.14
*C*78492*TC*1746.84*1659.50*1908.43
*C*78608**1819.16*1728.20*1987.43
*C*78608*TC*1746.84*1659.50*1908.43
*C*78811**1660.10*1577.10*1813.67
*C*78811*TC*1585.66*1506.38*1732.34
*C*78812**1840.91*1748.86*2011.19
*C*78812*TC*1746.84*1659.50*1908.43
*C*78813**1842.97*1750.82*2013.44
*C*78813*TC*1746.84*1659.50*1908.43
*C*78814**1853.35*1760.68*2024.78
*C*78814*TC*1746.84*1659.50*1908.43
*C*78815**1865.50*1772.23*2038.06
*C*78815*TC*1746.84*1659.50*1908.43
*C*78816**1866.48*1773.16*2039.13
*C*78816*TC*1746.84*1659.50*1908.43
**79300**237.04*225.19*258.97
**79300*TC*171.03*162.48*186.85
**79445**237.04*225.19*258.97
**79445*TC*122.98*116.83*134.35
**86485**6.24*5.93*6.82
**90867**335.98*319.18*367.06
#**90867**147.75*140.36*161.41
**90868**222.75*211.61*243.35
#**90868**112.72*107.08*123.14
**90869**306.33*291.01*334.66
#**90869**175.94*167.14*192.21
**90952**527.32*500.95*576.09
**90953**377.83*358.94*412.78
**92978**275.00*261.25*300.44
**92978*TC*177.01*168.16*193.38
**92979**165.58*157.30*180.90
**92979*TC*87.82*83.43*95.94
*C*93315**747.57*710.19*816.72
*C*93315*TC*615.89*585.10*672.87
**93317**238.82*226.88*260.91
**93317*TC*147.25*139.89*160.87
*C*93318**721.72*685.63*788.47
*C*93318*TC*615.89*585.10*672.87
**93571**273.85*260.16*299.18
**93571*TC*199.29*189.33*217.73
**93572**162.94*154.79*178.01
**93572*TC*108.63*103.20*118.68
**93600**3557.81*3379.92*3886.91
**93600*TC*3437.43*3265.56*3755.39
**93602**3557.81*3379.92*3886.91
**93602*TC*3439.64*3267.66*3757.81
**93603**3557.81*3379.92*3886.91
**93603*TC*3439.64*3267.66*3757.81
**93609**2134.69*2027.96*2332.15
**93609*TC*1852.32*1759.70*2023.66
**93610**3557.81*3379.92*3886.91
**93610*TC*3390.98*3221.43*3704.64
**93612**3557.81*3379.92*3886.91
**93612*TC*3393.53*3223.85*3707.43
**93619**7115.62*6759.84*7773.82
**93619*TC*6716.87*6381.03*7338.18
**93620**7115.62*6759.84*7773.82
**93620*TC*6475.89*6152.10*7074.92
**93621**7115.62*6759.84*7773.82
**93621*TC*7030.53*6679.00*7680.85
**93622**7115.62*6759.84*7773.82
**93622*TC*6940.09*6593.09*7582.05
**93623**2134.69*2027.96*2332.15
**93623*TC*2063.04*1959.89*2253.87
**93624**3557.81*3379.92*3886.91
**93624*TC*3310.45*3144.93*3616.67
**93631**7115.62*6759.84*7773.82
**93631*TC*6708.58*6373.15*7329.12
**93640**1133.95*1077.25*1238.84
**93640*TC*951.41*903.84*1039.42
**93641**1133.95*1077.25*1238.84
**93641*TC*814.81*774.07*890.18
**93662**481.65*457.57*526.21
**93662*TC*408.25*387.84*446.02
**93745**102.51*97.38*111.99
**93745*TC*76.87*73.03*83.98
**93745*26*25.62*24.34*27.99
**94642**37.33*35.46*40.78
**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
**95965**986.03*936.73*1077.24
**95965*TC*552.69*525.06*603.82
**96020**392.66*373.03*428.98
**96020*TC*228.13*216.72*249.23
**96547**850.72*808.18*929.41
#**96547**145.75*138.46*159.23
**96548**425.36*404.09*464.70
#**96548**72.87*69.23*79.61
**97039**15.29*14.53*16.71
**97139**20.73*19.69*22.64
**97151**52.94*50.29*57.83
#**97151**46.41*44.09*50.70
**97152**45.00*42.75*49.16
#**97152**39.45*37.48*43.10
**97153**35.79*34.00*39.10
#**97153**30.99*29.44*33.86
**97154**4.90*4.66*5.36
#**97154**4.41*4.19*4.82
**97155**35.79*34.00*39.10
#**97155**30.99*29.44*33.86
**97156**37.72*35.83*41.20
#**97156**32.73*31.09*35.75
**97157**11.07*10.52*12.10
#**97157**9.92*9.42*10.83
**97158**5.71*5.42*6.23
#**97158**5.13*4.87*5.60
**98978**54.45*51.73*59.49
# - 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.