NEW JERSEY MEDICARE CARRIER - 12402
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**487.55*463.17*532.65
#**G0186**417.30*396.44*455.91
**G0339**3187.66*3028.28*3482.52
**G0340**2397.40*2277.53*2619.16
**G0398**145.92*138.62*159.41
**G0398*TC*105.72*100.43*115.49
**G0398*26*40.19*38.18*43.91
**G0399**100.48*95.46*109.78
**G0399*TC*56.11*53.30*61.30
**G0399*26*44.73*42.49*48.86
**G0400**103.91*98.71*113.52
**G0400*TC*62.27*59.16*68.03
**G0400*26*41.64*39.56*45.49
**G0460**861.10*818.05*940.76
#**G0460**125.57*119.29*137.18
**G0465**861.10*818.05*940.76
#**G0465**125.57*119.29*137.18
**G0498**159.55*151.57*174.31
**G6017**83.00*78.85*90.68
**0042T**243.24*231.08*265.74
**0054T**241.48*229.41*263.82
**0055T**241.48*229.41*263.82
**0071T**603.11*572.95*658.89
**0072T**603.11*572.95*658.89
**0075T**1007.20*956.84*1100.37
**0075T*TC*1007.20*956.84*1100.37
**0075T*26*1008.94*958.49*1102.26
**0076T**1114.35*1058.63*1217.42
**0076T*TC*891.48*846.91*973.95
**0076T*26*222.88*211.74*243.50
**0095T**661.31*628.24*722.48
**0098T**739.82*702.83*808.25
**0100T**1998.21*1898.30*2183.05
**0101T**333.19*316.53*364.01
#**0101T**237.22*225.36*259.16
**0102T**333.19*316.53*364.01
#**0102T**237.22*225.36*259.16
**0106T**36.45*34.63*39.82
**0107T**36.45*34.63*39.82
**0108T**36.45*34.63*39.82
**0109T**36.45*34.63*39.82
**0110T**36.45*34.63*39.82
**0164T**723.26*687.10*790.17
**0165T**740.93*703.88*809.46
**0174T**10.25*9.74*11.20
**0184T**868.30*824.89*948.62
**0198T**91.05*86.50*99.48
#**0198T**33.10*31.45*36.17
**0200T**1915.06*1819.31*2092.21
#**0200T**420.82*399.78*459.75
**0201T**2872.58*2728.95*3138.29
#**0201T**631.23*599.67*689.62
**0207T**121.70*115.62*132.96
**0208T**41.27*39.21*45.09
**0209T**49.96*47.46*54.58
**0210T**31.50*29.93*34.42
**0211T**48.88*46.44*53.41
**0212T**38.19*36.28*41.72
#**0212T**32.76*31.12*35.79
**0213T**205.65*195.37*224.68
#**0213T**109.68*104.20*119.83
**0214T**103.17*98.01*112.71
#**0214T**61.16*58.10*66.82
**0215T**103.53*98.35*113.10
#**0215T**62.25*59.14*68.01
**0216T**189.66*180.18*207.21
#**0216T**94.41*89.69*103.14
**0217T**96.65*91.82*105.59
#**0217T**52.47*49.85*57.33
**0218T**96.65*91.82*105.59
#**0218T**53.55*50.87*58.50
**0219T**1393.86*1324.17*1522.80
**0220T**1369.20*1300.74*1495.85
**0221T**1673.24*1589.58*1828.02
**0222T**407.72*387.33*445.43
**0232T**861.10*818.05*940.76
#**0232T**125.57*119.29*137.18
**0234T**9269.07*8805.62*10126.46
#**0234T**602.80*572.66*658.56
**0235T**9269.07*8805.62*10126.46
#**0235T**602.80*572.66*658.56
**0236T**9427.08*8955.73*10299.09
#**0236T**697.43*662.56*761.94
**0237T**9427.08*8955.73*10299.09
#**0237T**697.43*662.56*761.94
**0238T**9427.08*8955.73*10299.09
#**0238T**697.43*662.56*761.94
**0253T**989.44*939.97*1080.97
**0266T**936.99*890.14*1023.66
**0267T**163.78*155.59*178.93
**0268T**349.62*332.14*381.96
**0269T**888.69*844.26*970.90
**0270T**163.78*155.59*178.93
**0271T**349.62*332.14*381.96
**0272T**59.92*56.92*65.46
**0273T**76.24*72.43*83.29
**0274T**1172.41*1113.79*1280.86
**0278T**15.04*14.29*16.43
**0308T**1467.65*1394.27*1603.41
**0329T**91.05*86.50*99.48
#**0329T**33.10*31.45*36.17
**0330T**38.21*36.30*41.75
**0331T**197.42*187.55*215.68
**0332T**337.05*320.20*368.23
**0347T**147.72*140.33*161.38
**0348T**35.41*33.64*38.69
**0349T**37.62*35.74*41.10
**0350T**38.35*36.43*41.89
**0351T**182.61*173.48*199.50
**0352T**44.64*42.41*48.77
**0353T**182.61*173.48*199.50
**0354T**44.64*42.41*48.77
**0358T**29.32*27.85*32.03
**0362T**96.02*91.22*104.90
#**0362T**68.14*64.73*74.44
**0378T**25.76*24.47*28.14
**0394T**269.30*255.84*294.22
**0395T**649.74*617.25*709.84
**0397T**48.73*46.29*53.23
**0398T*26*1718.37*1632.45*1877.32
**0403T**26.95*25.60*29.44
**0408T**532.09*505.49*581.31
**0409T**369.29*350.83*403.45
**0410T**384.33*365.11*419.88
**0411T**384.33*365.11*419.88
**0412T**243.16*231.00*265.65
**0413T**499.00*474.05*545.16
**0414T**385.00*365.75*420.61
**0415T**320.41*304.39*350.05
**0416T**357.15*339.29*390.18
**0417T**88.71*84.27*96.91
**0418T**59.92*56.92*65.46
**0419T**477.86*453.97*522.07
#**0419T**380.80*361.76*416.02
**0420T**677.30*643.44*739.96
#**0420T**557.43*529.56*608.99
**0421T**1718.66*1632.73*1877.64
#**0421T**723.11*686.95*789.99
**0437T**222.18*211.07*242.73
**0439T**76.93*73.08*84.04
**0440T**265.76*252.47*290.34
#**0440T**124.52*118.29*136.03
**0441T**265.76*252.47*290.34
#**0441T**124.52*118.29*136.03
**0442T**265.76*252.47*290.34
#**0442T**124.52*118.29*136.03
**0449T**803.52*763.34*877.84
**0464T**72.40*68.78*79.10
**0472T**71.39*67.82*77.99
**0473T**59.92*56.92*65.46
**0479T**65.61*62.33*71.68
**0480T**83.33*79.16*91.03
#**0480T**32.81*31.17*35.85
**0483T**1229.30*1167.84*1343.02
**0484T**1593.28*1513.62*1740.66
**0485T**24.95*23.70*27.26
**0485T*TC*9.58*9.10*10.47
**0485T*26*15.72*14.93*17.17
**0486T**49.91*47.41*54.52
**0486T*TC*18.82*17.88*20.56
**0486T*26*31.09*29.54*33.97
**0488T**65.90*62.61*72.00
#**0488T**51.78*49.19*56.57
**0505T**12250.64*11638.11*13383.83
#**0505T**573.52*544.84*626.57
**0507T**25.22*23.96*27.55
**0507T*TC*22.08*20.98*24.13
**0507T*26*3.14*2.98*3.43
**0510T**642.08*609.98*701.48
#**0510T**446.52*424.19*487.82
**0512T**333.19*316.53*364.01
#**0512T**237.22*225.36*259.16
**0513T**99.96*94.96*109.20
#**0513T**71.17*67.61*77.75
**0515T**532.09*505.49*581.31
**0516T**491.42*466.85*536.88
**0517T**349.62*332.14*381.96
**0518T**243.16*231.00*265.65
**0519T**350.77*333.23*383.21
**0520T**491.42*466.85*536.88
**0521T**59.92*56.92*65.46
**0521T*TC*39.10*37.15*42.72
**0521T*26*20.82*19.78*22.75
**0522T**71.39*67.82*77.99
**0522T*TC*39.82*37.83*43.50
**0522T*26*31.57*29.99*34.49
**0523T**161.81*153.72*176.78
**0524T**1776.11*1687.30*1940.40
#**0524T**182.28*173.17*199.15
**0525T**491.78*467.19*537.27
**0526T**384.33*365.11*419.88
**0527T**333.96*317.26*364.85
**0528T**71.39*67.82*77.99
**0528T*TC*39.82*37.83*43.50
**0528T*26*31.57*29.99*34.49
**0529T**59.92*56.92*65.46
**0529T*TC*39.10*37.15*42.72
**0529T*26*20.82*19.78*22.75
**0530T**656.27*623.46*716.98
**0531T**499.00*474.05*545.16
**0532T**350.77*333.23*383.21
**0540T**185.05*175.80*202.17
**0543T**1593.28*1513.62*1740.66
**0544T**1837.03*1745.18*2006.96
**0545T**1837.03*1745.18*2006.96
**0546T**76.27*72.46*83.33
**0552T**7.11*6.75*7.76
**0553T**2648.58*2516.15*2893.57
#**0553T**402.88*382.74*440.15
**0565T**651.83*619.24*712.13
#**0565T**543.54*516.36*593.81
**0566T**105.80*100.51*115.59
#**0566T**61.25*58.19*66.92
**0569T**1837.03*1745.18*2006.96
**0570T**429.53*408.05*469.26
**0571T**575.98*547.18*629.26
**0572T**468.57*445.14*511.91
**0573T**358.71*340.77*391.89
**0574T**415.15*394.39*453.55
**0575T**71.39*67.82*77.99
**0576T**59.92*56.92*65.46
**0577T**199.57*189.59*218.03
**0578T**30.20*28.69*32.99
**0579T**23.17*22.01*25.31
**0580T**223.47*212.30*244.15
**0581T**2454.10*2331.40*2681.11
#**0581T**218.18*207.27*238.36
**0582T**1786.22*1696.91*1951.45
#**0582T**402.44*382.32*439.67
**0583T**1496.16*1421.35*1634.55
#**0583T**140.99*133.94*154.03
**0587T**469.00*445.55*512.38
#**0587T**308.21*292.80*336.72
**0588T**387.57*368.19*423.42
#**0588T**240.90*228.86*263.19
**0589T**50.43*47.91*55.10
#**0589T**39.93*37.93*43.62
**0590T**59.79*56.80*65.32
#**0590T**41.32*39.25*45.14
**0596T**2235.23*2123.47*2441.99
#**0596T**134.57*127.84*147.02
**0597T**672.69*639.06*734.92
#**0597T**134.57*127.84*147.02
**0598T**163.85*155.66*179.01
**0599T**108.83*103.39*118.90
**0600T**3850.78*3658.24*4206.98
#**0600T**745.70*708.42*814.68
**0601T**1512.35*1436.73*1652.24
**0607T**19.36*18.39*21.15
**0608T**1217.40*1156.53*1330.01
**0609T**209.72*199.23*229.11
**0611T**44.16*41.95*48.24
**0614T**384.23*365.02*419.77
**0615T**49.62*47.14*54.21
**0616T**695.14*660.38*759.44
**0617T**778.28*739.37*850.28
**0618T**942.62*895.49*1029.81
**0619T**691.73*657.14*755.71
#**0619T**498.79*473.85*544.93
**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**277.04*263.19*302.67
#**0627T**103.21*98.05*112.76
**0628T**83.11*78.95*90.79
#**0628T**30.96*29.41*33.82
**0629T**277.04*263.19*302.67
#**0629T**103.21*98.05*112.76
**0630T**83.11*78.95*90.79
#**0630T**30.96*29.41*33.82
**0631T**88.87*84.43*97.09
**0632T**591.39*561.82*646.09
**0633T**216.02*205.22*236.00
*C*0633T*TC*115.88*110.09*126.60
**0633T*26*60.68*57.65*66.30
**0634T**216.02*205.22*236.00
**0634T*TC*155.34*147.57*169.71
**0634T*26*60.68*57.65*66.30
**0635T**216.02*205.22*236.00
**0635T*TC*155.34*147.57*169.71
**0635T*26*60.68*57.65*66.30
**0636T**216.02*205.22*236.00
**0636T*TC*155.34*147.57*169.71
**0636T*26*60.68*57.65*66.30
**0637T**216.02*205.22*236.00
**0637T*TC*155.34*147.57*169.71
**0637T*26*60.68*57.65*66.30
**0638T**216.02*205.22*236.00
**0638T*TC*155.34*147.57*169.71
**0638T*26*60.68*57.65*66.30
**0639T**88.87*84.43*97.09
**0640T**25.22*23.96*27.55
**0640T*TC*22.08*20.98*24.13
**0640T*26*3.14*2.98*3.43
**0644T**1249.84*1187.35*1365.45
#**0644T**245.59*233.31*268.31
**0646T**1837.03*1745.18*2006.96
**0648T**350.51*332.98*382.93
**0648T*TC*235.45*223.68*257.23
**0648T*26*115.06*109.31*125.71
**0650T**63.70*60.52*69.60
**0652T**307.84*292.45*336.32
#**0652T**126.77*120.43*138.49
**0653T**403.13*382.97*440.42
#**0653T**143.11*135.95*156.34
**0654T**146.85*139.51*160.44
**0655T**1718.66*1632.73*1877.64
#**0655T**723.11*686.95*789.99
**0658T**103.20*98.04*112.75
**0659T**2901.54*2756.46*3169.93
#**0659T**444.35*422.13*485.45
**0671T**1079.97*1025.97*1179.87
**0673T**3710.87*3525.33*4054.13
#**0673T**375.83*357.04*410.60
**0699T**118.89*112.95*129.89
#**0699T**94.99*90.24*103.78
**0707T**397.35*377.48*434.10
#**0707T**297.03*282.18*324.51
**0714T**1515.39*1439.62*1655.56
#**0714T**376.07*357.27*410.86
**0730T**288.61*274.18*315.31
#**0730T**257.42*244.55*281.23
**0738T**73.59*69.91*80.40
**0739T**1718.66*1632.73*1877.64
#**0739T**723.11*686.95*789.99
**0740T**21.70*20.62*23.71
**0741T**51.41*48.84*56.17
**0742T**101.11*96.05*110.46
**0742T*TC*81.47*77.40*89.01
**0742T*26*19.65*18.67*21.47
**0743T**57.28*54.42*62.58
**0744T**913.16*867.50*997.63
**0745T**279.50*265.53*305.36
**0746T**233.43*221.76*255.02
**0747T**1080.72*1026.68*1180.68
**0748T**192.18*182.57*209.96
**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**465.92*442.62*509.01
**0756T**120.16*114.15*131.27
**0757T**87.84*83.45*95.97
**0758T**96.81*91.97*105.77
**0759T**145.16*137.90*158.59
**0760T**106.43*101.11*116.28
**0761T**0.01*0.01*0.01
**0762T**0.01*0.01*0.01
**0763T**125.67*119.39*137.30
**0764T**4.56*4.33*4.98
**0765T**8.32*7.90*9.09
**0771T**27.24*25.88*29.76
**0772T**27.24*25.88*29.76
**0773T**24.96*23.71*27.27
**0774T**24.96*23.71*27.27
**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**474.02*450.32*517.87
**0779T*TC*447.24*424.88*488.61
**0779T*26*26.77*25.43*29.24
**0780T**24.96*23.71*27.27
**0783T**15.56*14.78*17.00
**0784T**2292.63*2178.00*2504.70
#**0784T**337.74*320.85*368.98
**0785T**258.86*245.92*282.81
#**0785T**152.03*144.43*166.09
**0786T**784.44*745.22*857.00
#**0786T**315.81*300.02*345.02
**0787T**258.86*245.92*282.81
#**0787T**152.03*144.43*166.09
**0788T**19.51*18.53*21.31
#**0788T**18.79*17.85*20.53
**0789T**27.28*25.92*29.81
#**0789T**23.48*22.31*25.66
**0790T**1995.92*1896.12*2180.54
**0791T**9.52*9.04*10.40
**0793T**591.39*561.82*646.09
**0794T**130.35*123.83*142.40
**0795T**737.13*700.27*805.31
**0796T**491.42*466.85*536.88
**0797T**491.42*466.85*536.88
**0798T**777.70*738.82*849.64
**0799T**518.47*492.55*566.43
**0800T**518.47*492.55*566.43
**0801T**1009.89*959.40*1103.31
**0802T**504.94*479.69*551.64
**0803T**504.94*479.69*551.64
**0804T**83.46*79.29*91.18
**0804T*TC*45.98*43.68*50.23
**0804T*26*37.47*35.60*40.94
**0805T**3200.73*3040.69*3496.79
#**0805T**333.59*316.91*364.45
**0806T**4267.65*4054.27*4662.41
#**0806T**444.78*422.54*485.92
**0807T**45.68*43.40*49.91
**0807T*TC*30.41*28.89*33.22
**0807T*26*15.27*14.51*16.69
**0808T**45.68*43.40*49.91
**0808T*TC*30.41*28.89*33.22
**0808T*26*15.27*14.51*16.69
**0810T**1188.66*1129.23*1298.61
**0811T**21.70*20.62*23.71
**0813T**2817.42*2676.55*3078.03
#**0813T**187.48*178.11*204.83
**0814T**496.68*471.85*542.63
#**0814T**371.29*352.73*405.64
**0818T**387.57*368.19*423.42
#**0818T**240.90*228.86*263.19
**0820T**152.35*144.73*166.44
#**0820T**133.16*126.50*145.48
**0821T**152.35*144.73*166.44
#**0821T**133.16*126.50*145.48
**0822T**129.50*123.03*141.48
#**0822T**113.18*107.52*123.65
**0823T**737.13*700.27*805.31
**0824T**777.70*738.82*849.64
**0825T**1009.89*959.40*1103.31
**0826T**71.39*67.82*77.99
**0826T*TC*39.82*37.83*43.50
**0826T*26*31.57*29.99*34.49
**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**25.22*23.96*27.55
**0859T*TC*22.08*20.98*24.13
**0859T*26*3.14*2.98*3.43
**0864T**333.19*316.53*364.01
#**0864T**237.22*225.36*259.16
**10011**458.19*435.28*500.57
#**10011**110.89*105.35*121.15
**10012**251.60*239.02*274.87
#**10012**73.43*69.76*80.22
**15847**370.34*351.82*404.59
**21088**1901.72*1806.63*2077.62
**21742**1202.90*1142.76*1314.17
**21743**1381.81*1312.72*1509.63
**32855**466.04*442.74*509.15
**32856**467.53*444.15*510.77
**33928**3414.26*3243.55*3730.08
**33929**1278.82*1214.88*1397.11
**33933**570.95*542.40*623.76
**33944**528.17*501.76*577.02
**34841**2228.10*2116.70*2434.21
**34842**2453.87*2331.18*2680.86
**34843**2679.66*2545.68*2927.53
**34844**2905.43*2760.16*3174.18
**34845**2228.10*2116.70*2434.21
**34846**2453.87*2331.18*2680.86
**34847**2679.66*2545.68*2927.53
**34848**2905.43*2760.16*3174.18
**43496**2274.24*2160.53*2484.61
**43647**816.08*775.28*891.57
**43648**576.56*547.73*629.89
#**43648**256.76*243.92*280.51
**43881**742.91*705.76*811.62
#**43881**678.83*644.89*741.62
**43882**792.42*752.80*865.72
#**43882**723.43*687.26*790.35
**44137**1827.98*1736.58*1997.07
**44715**466.04*442.74*509.15
**47143**447.22*424.86*488.59
**47144**531.09*504.54*580.22
**47145**503.13*477.97*549.67
**48551**349.25*331.79*381.56
**49906**2208.11*2097.70*2412.36
**50323**419.88*398.89*458.72
**50325**287.61*273.23*314.21
**53451**791.46*751.89*864.67
**53452**395.73*375.94*432.33
**53453**672.77*639.13*735.00
**53454**60.03*57.03*65.58
#**53454**36.49*34.67*39.87
**54440**786.02*746.72*858.73
**63043**608.36*577.94*664.63
**63044**557.71*529.82*609.29
**64596**2292.63*2178.00*2504.70
#**64596**337.74*320.85*368.98
**64597**687.79*653.40*751.41
#**64597**101.32*96.25*110.69
**64598**258.86*245.92*282.81
#**64598**152.03*144.43*166.09
**65757**125.84*119.55*137.48
**66983**695.14*660.38*759.44
**66987**798.81*758.87*872.70
**66988**665.66*632.38*727.24
*C*70170**273.12*259.46*298.38
*C*70170*TC*258.20*245.29*282.08
**70555**233.47*221.80*255.07
**70555*TC*112.19*106.58*122.57
*C*70557**737.97*701.07*806.23
*C*70557*TC*581.24*552.18*635.01
*C*70558**366.49*348.17*400.40
*C*70558*TC*193.74*184.05*211.66
*C*70559**355.48*337.71*388.37
*C*70559*TC*193.74*184.05*211.66
*C*74190**603.74*573.55*659.58
*C*74190*TC*581.24*552.18*635.01
**74235**156.49*148.67*170.97
**74235*TC*98.58*93.65*107.70
**74300**91.61*87.03*100.08
**74300*TC*78.08*74.18*85.31
**74301**28.22*26.81*30.83
**74301*TC*18.17*17.26*19.85
**74328**175.06*166.31*191.26
**74328*TC*151.44*143.87*165.45
**74329**153.22*145.56*167.39
**74329*TC*129.24*122.78*141.20
**74330**262.59*249.46*286.88
**74330*TC*234.83*223.09*256.55
**74340**86.58*82.25*94.59
**74340*TC*60.59*57.56*66.19
**74355**86.58*82.25*94.59
**74355*TC*49.47*47.00*54.05
**74360**86.58*82.25*94.59
**74360*TC*58.80*55.86*64.24
**74363**175.06*166.31*191.26
**74363*TC*132.78*126.14*145.06
*C*74445**170.66*162.13*186.45
*C*74445*TC*115.88*110.09*126.60
*C*74450**274.16*260.45*299.52
*C*74450*TC*258.20*245.29*282.08
*C*74470**606.51*576.18*662.61
*C*74470*TC*581.24*552.18*635.01
**74742**233.47*221.80*255.07
**74742*TC*203.64*193.46*222.48
*C*74775**288.37*273.95*315.04
*C*74775*TC*258.20*245.29*282.08
*C*75801**705.78*670.49*771.06
*C*75801*TC*662.00*628.90*723.24
*C*75803**1744.84*1657.60*1906.24
*C*75803*TC*1687.61*1603.23*1843.71
*C*75805**3398.48*3228.56*3712.84
*C*75805*TC*3358.94*3190.99*3669.64
*C*75807**3412.52*3241.89*3728.17
*C*75807*TC*3358.94*3190.99*3669.64
*C*75810**3407.85*3237.46*3723.08
*C*75810*TC*3358.94*3190.99*3669.64
**75894**983.80*934.61*1074.80
**75894*TC*910.46*864.94*994.68
*C*75898**3452.46*3279.84*3771.82
*C*75898*TC*3358.94*3190.99*3669.64
**75970**479.79*455.80*524.17
**75970*TC*441.40*419.33*482.23
**76125**42.79*40.65*46.75
**76125*TC*29.26*27.80*31.97
**76390**222.02*210.92*242.56
**76390*TC*168.37*159.95*183.94
**76390*26*53.65*50.97*58.62
**76932**91.10*86.55*99.53
**76932*TC*54.23*51.52*59.25
**76940**167.63*159.25*183.14
**76940*TC*64.95*61.70*70.96
**76941**123.27*117.11*134.68
**76941*TC*57.67*54.79*63.01
**76945**90.02*85.52*98.35
**76945*TC*57.39*54.52*62.70
*C*76975**299.93*284.93*327.67
*C*76975*TC*258.20*245.29*282.08
**76998**175.06*166.31*191.26
**76998*TC*127.18*120.82*138.94
**77013**458.72*435.78*501.15
**77013*TC*272.91*259.26*298.15
**77022**509.75*484.26*556.90
**77022*TC*306.68*291.35*335.05
**77371**1424.47*1353.25*1556.24
**77520**1006.44*956.12*1099.54
**77522**1006.44*956.12*1099.54
**77523**1155.64*1097.86*1262.54
**77525**1304.84*1239.60*1425.54
*C*78282**450.06*427.56*491.69
*C*78282*TC*434.57*412.84*474.77
**78414**514.99*489.24*562.63
**78414*TC*493.49*468.82*539.14
*C*78429**1728.76*1642.32*1888.67
*C*78429*TC*1648.50*1566.08*1800.99
*C*78430**1724.97*1638.72*1884.53
*C*78430*TC*1648.50*1566.08*1800.99
*C*78431**2578.43*2449.51*2816.94
*C*78431*TC*2489.05*2364.60*2719.29
*C*78432**2142.03*2034.93*2340.17
*C*78432*TC*2046.50*1944.18*2235.81
*C*78433**2261.86*2148.77*2471.09
*C*78433*TC*2157.32*2049.45*2356.87
**78434**773.53*734.85*845.08
**78434*TC*744.09*706.89*812.92
*C*78459**1570.81*1492.27*1716.11
*C*78459*TC*1496.40*1421.58*1634.82
*C*78491**1721.58*1635.50*1880.83
*C*78491*TC*1648.50*1566.08*1800.99
*C*78492**1734.47*1647.75*1894.91
*C*78492*TC*1648.50*1566.08*1800.99
*C*78608**1718.80*1632.86*1877.79
*C*78608*TC*1648.50*1566.08*1800.99
*C*78811**1568.77*1490.33*1713.88
*C*78811*TC*1496.40*1421.58*1634.82
*C*78812**1739.95*1652.95*1900.89
*C*78812*TC*1648.50*1566.08*1800.99
*C*78813**1741.98*1654.88*1903.11
*C*78813*TC*1648.50*1566.08*1800.99
*C*78814**1752.05*1664.45*1914.12
*C*78814*TC*1648.50*1566.08*1800.99
*C*78815**1763.85*1675.66*1927.01
*C*78815*TC*1648.50*1566.08*1800.99
*C*78816**1764.82*1676.58*1928.07
*C*78816*TC*1648.50*1566.08*1800.99
**79300**237.04*225.19*258.97
**79300*TC*172.70*164.07*188.68
**79445**237.04*225.19*258.97
**79445*TC*125.99*119.69*137.64
**86485**6.01*5.71*6.57
**90867**320.74*304.70*350.41
#**90867**143.10*135.95*156.34
**90868**213.64*202.96*233.40
#**90868**109.16*103.70*119.26
**90869**293.82*279.13*321.00
#**90869**169.46*160.99*185.14
**90952**512.12*486.51*559.49
**90953**366.32*348.00*400.20
**92978**262.95*249.80*287.27
**92978*TC*167.18*158.82*182.64
**92979**158.85*150.91*173.55
**92979*TC*82.87*78.73*90.54
*C*93315**709.13*673.67*774.72
*C*93315*TC*581.24*552.18*635.01
**93317**228.85*217.41*250.02
**93317*TC*139.78*132.79*152.71
*C*93318**684.15*649.94*747.43
*C*93318*TC*581.24*552.18*635.01
**93571**261.87*248.78*286.10
**93571*TC*189.01*179.56*206.49
**93572**156.33*148.51*170.79
**93572*TC*103.25*98.09*112.80
**93600**3557.81*3379.92*3886.91
**93600*TC*3440.33*3268.31*3758.56
**93602**3557.81*3379.92*3886.91
**93602*TC*3442.48*3270.36*3760.91
**93603**3557.81*3379.92*3886.91
**93603*TC*3442.48*3270.36*3760.91
**93609**2134.69*2027.96*2332.15
**93609*TC*1859.10*1766.15*2031.07
**93610**3557.81*3379.92*3886.91
**93610*TC*3394.94*3225.19*3708.97
**93612**3557.81*3379.92*3886.91
**93612*TC*3397.44*3227.57*3711.71
**93619**7115.62*6759.84*7773.82
**93619*TC*6726.42*6390.10*7348.62
**93620**7115.62*6759.84*7773.82
**93620*TC*6491.16*6166.60*7091.59
**93621**7115.62*6759.84*7773.82
**93621*TC*7032.56*6680.93*7683.07
**93622**7115.62*6759.84*7773.82
**93622*TC*6944.29*6597.08*7586.64
**93623**2134.69*2027.96*2332.15
**93623*TC*2065.27*1962.01*2256.31
**93624**3557.81*3379.92*3886.91
**93624*TC*3315.99*3150.19*3622.72
**93631**7115.62*6759.84*7773.82
**93631*TC*6717.28*6381.42*7338.63
**93640**1133.95*1077.25*1238.84
**93640*TC*955.74*907.95*1044.14
**93641**1133.95*1077.25*1238.84
**93641*TC*822.32*781.20*898.38
**93662**460.60*437.57*503.21
**93662*TC*389.43*369.96*425.45
**93745**98.93*93.98*108.08
**93745*TC*74.20*70.49*81.06
**93745*26*24.76*23.52*27.05
**94642**36.01*34.21*39.34
**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**960.47*912.45*1049.32
**95965*TC*540.52*513.49*590.51
**96020**380.12*361.11*415.28
**96020*TC*220.16*209.15*240.52
**96547**805.88*765.59*880.43
#**96547**140.61*133.58*153.62
**96548**402.94*382.79*440.21
#**96548**70.31*66.79*76.81
**97039**14.78*14.04*16.15
**97139**19.99*18.99*21.84
**97151**51.43*48.86*56.19
#**97151**45.28*43.02*49.47
**97152**43.72*41.53*47.76
#**97152**38.48*36.56*42.04
**97153**34.78*33.04*38.00
#**97153**30.25*28.74*33.05
**97154**4.77*4.53*5.21
#**97154**4.31*4.09*4.70
**97155**34.78*33.04*38.00
#**97155**30.25*28.74*33.05
**97156**36.67*34.84*40.07
#**97156**31.96*30.36*34.91
**97157**10.75*10.21*11.74
#**97157**9.67*9.19*10.57
**97158**5.55*5.27*6.06
#**97158**5.01*4.76*5.47
**98978**51.41*48.84*56.17
# - 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.